HSR&D Citation Abstract
Search | Search by Center | Search by Source | Keywords in Title
Racial and Ethnic Differences in End-of-Life Care for Patients with End-Stage Renal Disease
Pham C, Braun UK. Racial and Ethnic Differences in End-of-Life Care for Patients with End-Stage Renal Disease. [Abstract]. Journal of pain and symptom management. 2009 Mar 1; 37(3):556-557.
1. Discuss the differences in care by race/ethnicity
for patients with end-stage renal disease.
I. Background. Patients with end-stage renal
disease are known to have different rates of receiving
kidney transplants by race/ethnicity. No
national data exist regarding racial/ethnic differences
for patients with end-stage renal disease in
the use of common life-sustaining interventions
often given at the end of life.
II. Research Objectives. To determine whether
among veterans with end-stage renal disease the
use of common life-sustaining treatments differed
significantly by race/ethnicity.
Design. Retrospective cohort study during fiscal
Patients. Hospitalized veterans age 55 years or
older with end-stage renal disease, on hemodialysis
or peritoneal dialysis, identified by ICD-9 codes
and CPT codes.
Measurements. Utilization patterns by race/
ethnicity for five life-sustaining therapies. Logistic
regression models evaluated differences
among Caucasians, African Americans, and
Hispanics, controlling for age, disease burden
(using the Deyo score), and clustering of patients
within VA medical centers.
IV. Results. Among 14,252 veterans 99% were
male, 70% were between 55 and 75 years old,
and 30% were > 75 years. 63% died within 6
months of being identified for the study. 60.5%
of patients were Caucasian; 34.5%, African
American; and 5%, Hispanic. Both differences
and commonalities were found by race/ethnicity.
African Americans were less likely to
be intubated (OR = .82 [.70-.86]; P = .0001),
resuscitated (OR = .724 [.63-.83]; P = .0001),
and had a trend toward receiving less ICU care
(OR = .93 [.88-.99]; P = .019) than Caucasians;
however, they were slightly more likely to receive
transfusions. Hispanics were more likely to be
transfused (OR = 1.214 [1.071-1.376]; P = .003),
resuscitated (OR = 1.31 [1.02-1.68]; P = .035),
or in the ICU (OR = 1.18 [1.04-1.34]; P = .013)
than Caucasians. No differences were found
for enteral feeding by race/ethnicity. Younger
patients were more likely to receive intubation,
resuscitation, or ICU care than older patients,
but there was no difference for transfusion or
enteral feeding by age group.
V. Conclusions. Differences in level of end-oflife
treatments were bidirectional for African
VI. Implications for research, policy, or practice.
In the absence of generally accepted, evidencebased
standards for end-of-life care, these
differences may or may not constitute disparities.
However, it is of concern that African Americans
received less intubation, resuscitation, and ICU
care than Caucasians in light of many studies on
patient preferences showing African Americans
generally preferring more aggressive end-of-life