title: Ethnic disparities in end-of-life care after subarachnoid hemorrhage.
abstract: BACKGROUND
  It is common for patients who die from subarachnoid hemorrhage to have a focus on comfort measures at the end of life. The potential role of ethnicity in end-of-life decisions after brain injury has not been extensively studied.
  
  
  METHODS
  Patients with subarachnoid hemorrhage were prospectively followed in an observational database. Demographic information including ethnicity was collected from medical records and self-reported by patients or their family. Significant in-hospital events including do-not-resuscitate orders, comfort measures only orders (CMO; care withheld or withdrawn), and mortality were recorded prospectively.
  
  
  RESULTS
  1255 patients were included in our analysis: 650 (52 %) were White, 387 (31 %) Hispanic, and 218 (17 %) Black. Mortality was similar between the groups. CMO was more commonly observed in Whites (14 %) compared to either Blacks (10 %) or Hispanics (9 %) (p = 0.04). In a multivariate analysis controlling for age and Hunt-Hess grade, Hispanics were less likely to have CMO than Whites (OR, 0.6; 95 %CI, 0.4-0.9; p = 0.02). Of the 229 patients who died, 77 % of Whites had CMO compared to 54 % of Blacks and 49 % of Hispanics (p < 0.01). In a multivariate analysis, Blacks (OR, 0.3; 95 %CI, 0.2-0.7; p < 0.01) and Hispanics (OR, 0.3; 95 %CI, 0.2-0.6; p < 0.01) were less likely to die with CMO orders than Whites.
  
  
  CONCLUSIONS
  After subarachnoid hemorrhage, Blacks and Hispanics are less likely to die with CMO orders than Whites. Further research to confirm and investigate the causes of these ethnic differences should be performed.
authors.affiliation: Departments of Neurosurgery and Neurology, The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 7.154, Houston, TX, 77030, USA, Huimahn.a.choi@uth.tmc.edu.
authors.forename: H Alex
authors.initials: HA
authors.lastname: Choi
authors.forename: Andres
authors.initials: A
authors.lastname: Fernandez
authors.forename: Sang-Beom
authors.initials: SB
authors.lastname: Jeon
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Prager
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000208:ethnology* / Q000628:therapy; D013727:Terminal Care; D044465:White People