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Who gets what? Race/ethnicity matter for treatment of seriously ill veterans

Braun U, Morgan RO, Ford ME, Beyth RJ. Who gets what? Race/ethnicity matter for treatment of seriously ill veterans. [Abstract]. Journal of the American Geriatrics Society. 2006 Apr 1; 54(S4):S180.




Abstract:

Background: Decisions about the use of invasive procedures at the end-of-life are difficult. Past studies noted differences in preferences for care by race/ethnicity; minorities usually chose more aggressive care. Despite available data on preferences for care, there is sparse national data on actual use of procedures in seriously ill elders. Purpose: To determine utilization patterns for resuscitation, mechanical ventilation, transfusion, enteral-parenteral nutrition, and ICU transfer in different cohorts of seriously ill veterans during fiscal years 1991-2002, by race/ethnicity, age, and over time. Methods: Retrospective cohort study using 2 national VA databases to identify cohorts of seriously ill elders > 55 years of age at high risk for 6-month mortality using ICD-9-codes: CHF with at least 1 more organ failure/insufficieny and at least 1 hospitalization in prior year; COPD and respiratory failure; multiorgan failure associated with sepsis; multi-organ failure, associated with cancer; metastatic lung cancer; colon carcinoma with liver metastases; or dementia with either malnutrition, aspiration pneumonia/pneumonia, or decubitus ulcer as a marker for later stage disease. For each disease cohort, we reported the number of discharges, age and race distribution, frequency and rate of procedures, and percentage of patients who died within 6 months of the index hospitalization. We used a logistic regression model using the chi-square statistic for categorical variables, t-test orWilcoxon rank-sum statistic for continuous variables to evaluate differences. Results: 174, 595 unique elders (69,460 with non-cancer diagnoses, 61,101 with cancer diagnoses, and 44,034 with dementia) were found. Hispanics received more intubation/ mechanical ventilation (OR 1.82, 95%CI 1.66-2.01 for Hispanic vs white, and OR 2.17, CI 1.95-2.41 for Hispanic vs African American) and transfusions, but less enteral feeding compared to whites and African Americans across all diagnoses (OR 0.62, CI 0.55-0.7); no differences for ICU use were found by race/ethnicity. Unexpectedly, African Americans were less likely to receive CPR compared to whites, OR 0.85, CI 0.78-0.92. Conclusion: Racial/ethnic variations in utilization of procedures exist in a national cohort of seriously ill elders. Further studies are needed to determine the appropriateness and quality of this care.





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