title: Ethnic Differences in Withdrawal of Life Support After Intracerebral Hemorrhage.
abstract: Minorities are less likely to decide on withdrawal of life support (WOLS) after acute severe illness. However, the decision-making process for WOLS after intracerebral hemorrhage (ICH) among Native Hawaiians and other Pacific Islanders (NHOPI) has not been described. To address this gap in the literature, a retrospective study was conducted on consecutive spontaneous ICH patients admitted to a tertiary center in Honolulu between 2006 and 2010. The occurrence of WOLS and time-to-WOLS were the outcome measures. Unadjusted and multivariable logistic regression models were performed to determine associations between NHOPI ethnicity and WOLS. This study assessed 396 patients (18% NHOPI, 63% Asians, 15% non-Hispanic whites [NHW], 4% others) with ICH. NHOPI was associated with lower rate of WOLS than NHW in the univariate analysis (OR 0.35, 95% CI: 0.15, 0.80). However, NHOPI ethnicity was no longer significant when adjusted for age (OR 0.59, 95% CI: 0.25, 1.43) and in the fully adjusted model (OR 0.68, 95% CI: 0.20, 2.39). Although NHOPI with ICH were initially perceived to have less WOLS compared to NHW, this observed difference was largely driven by the younger age of NHOPI rather than from underlying cultural differences that are inherent to their ethnicity.
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Shaw
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gallek
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Kate G
authors.initials: KG
authors.lastname: Sheppard
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Leslie
authors.initials: L
authors.lastname: Ritter
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Megan A
authors.initials: MA
authors.lastname: Vento
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Susan M
authors.initials: SM
authors.lastname: Asai
authors.affiliation: Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (KMS, MAV, SMA, KN).
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D002543:Cerebral Hemorrhage / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006254:Hawaii / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D028761:Withholding Treatment / Q000706:statistics & numerical data*