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Study Finds Disease-Specific Differences in End-of-Life Treatment of Seriously Ill Veterans of Different Ethnic and Racial Backgrounds


Our elderly population is growing rapidly and becoming more diverse, therefore, understanding the influence of race and ethnicity on end-of-life care is increasingly important. This study examined whether common life-sustaining treatments differed significantly among racially and ethnically diverse veterans who were hospitalized with a serious illness between FY91 and FY02. Using VA data, investigators identified African American, Caucasian, and Hispanic veterans who fell into one of three patient groups: advanced dementia (n=43,725), cancer (n=60,392), or non-cancer that included chronic heart failure, chronic obstructive pulmonary disease, and sepsis (n=61,942). Among these three groups, investigators compared the use of five life-sustaining therapies: resuscitation, mechanical ventilation, stay in an ICU, enteral nutrition (feeding tube), and blood transfusion.

Findings show that differences in the level of end-of-life treatments were disease-specific and not based on race and/or ethnicity. For example, African American veterans received more or the same amount of end-of-life treatments across disease cohorts, except for less resuscitation and mechanical ventilation for patients without cancer. Hispanic veterans received more or the same amount of end-of-life treatments across disease cohorts, but were 36% (cancer group), 55% (non-cancer group), and 88% (dementia group) more likely to receive transfusions than Caucasian veterans. Results also show that increased end-of-life care for minorities was most pronounced in veterans with dementia, and that non-cancer patients received more invasive care than patients with cancer or dementia, independent of their race or ethnicity.

Braun U, McCullough L, Beyth R, Wray N, Kunik M, and Morgan R. Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian, and Hispanic veterans. Journal of the National Medical Association September 2008;100(9):1041-51.

Dr. Braun was supported by an HSR&D Career Development Award; she and Dr. Morgan are part of HSR&D’s Houston Center for Quality of Care & Utilization Studies. Dr. Kunik is part of the South Central VA Mental Illness Research, Education and Clinical Center (MIRECC) and Dr. Beyth is part of the Geriatric Research, Education and Clinical Center in Gainesville.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.