title: Differences in level of care at the end of life according to race.
abstract: BACKGROUND
  Tailoring care for patients and their families at the end of life is important.
  
  
  OBJECTIVE
  To examine factors associated with patients' choices for level of care at the end of life.
  
  
  METHODS
  Data on demographics and level of care (full code, do not resuscitate, or withdrawal of life support) were collected on 1072 patients who died between January 1998 and June 2006 on a cardiac care unit. Logistic regression was used to identify factors associated with level of care.
  
  
  RESULTS
  Median (interquartile range) age of blacks was 64 (50-74) years and of whites was 70 (62-78) years. At the time of death, the level of care differed significantly between blacks and whites: 41.8% (n = 112) of blacks versus 26.7% (n = 194) of whites chose full code (P <.001), 37.3% (n = 96) of blacks versus 43.9% (n = 317) of whites chose do not resuscitate (P = .03), and 20.9% (n = 54) of blacks versus 29.3% (n = 210) of whites chose withdrawal of life support (P = .005). After age, sex, diagnosis, and lengths of stay in intensive care unit and hospital were controlled for, blacks were more likely than whites to choose full code status at the time of death (odds ratio 1.91 [95% confidence interval, 2.63-1.39], P < .001).
  
  
  CONCLUSIONS
  Blacks are 1.9 times as likely as others to choose full code at time of death. Cultural differences should be acknowledged when providing end-of-life care.
authors.affiliation: Heart Center at Duke University Health System in Durham, North Carolina, USA. johns151@mc.duke.edu
authors.forename: Rebecca W
authors.initials: RW
authors.lastname: Johnson
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Cook
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Melvin
authors.initials: M
authors.lastname: Echols
authors.forename: Wanda
authors.initials: W
authors.lastname: Bride
authors.forename: Bradi B
authors.initials: BB
authors.lastname: Granger
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data*