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• W2078102717 abstract "NASHVILLE, TENN. — The number of African Americans with noncancer diagnoses in hospices has continued to lag behind the number of white patients, despite increases for both racial groups since 1999. “Interventions to increase hospice use by African Americans with noncancer diagnoses may reduce the racial disparity in end-of-life care,” according to Dr. Kimberly S. Johnson, a physician in the division of geriatrics at Duke University in Durham, N.C. A literature review of articles published since 1990 on racial disparities in access to palliative medicine services found eight studies that documented the reduced use of hospices by African Americans and Asians, compared with whites, Dr. Alexie Cintron said in a separate report. Both physicians were speakers at the annual meeting of the American Academy of Hospice and Palliative Medicine. Several factors may explain the relatively low enrollment of African Americans in hospices, including a preference for more aggressive end-of-life care, mistrust of the health care system, cultural differences, and a different acceptance of death, said Dr. Johnson. In the past 20 years, hospice use has risen from about 158,000 patients in 1985 to more than 1 million patients in 2004, she said. According to data collected by the National Hospice and Palliative Care Organization, hospice enrollment for noncancer diagnoses rose from 24% of all hospice patients in 1992 to 54% in 2004. Dr. Johnson and her associates explored the impact of race on this trend by analyzing data from January 1999 to December 2003 for the patient database maintained by VITAS Healthcare, which operates several hospices in the U.S. The database included more than 166,000 patients, of whom about 15% were African American. For the study period, noncancer diagnoses accounted for 62% of hospice admissions among whites and 47% among African Americans. In 1999, noncancer diagnoses constituted about 58% of hospice admissions among whites, a level that steadily rose during the 5-year period to about 64% in 2003. Among African Americans, noncancer diagnoses were the reason for 42% of hospice admissions in 1999 and about 50% in 2003. The difference in the rates of noncancer hospice use between the two races was steady throughout the 5 years. The researchers ran a logistic regression analysis that controlled for several variables including gender, age, payment source for hospice care, location, and year of admission. The analysis showed that African Americans were 32% less likely to be admitted to a hospice for a noncancer diagnosis, compared with white patients, Dr. Johnson said. The literature review by Dr. Cintron examined several aspects of palliative care. He identified three studies that focused on pain assessment and treatment. These studies showed African Americans and Hispanics were less likely to have their pain level entered into their medical records than were whites, and they were also less likely to receive pain medication. The results from 14 studies showed African Americans were more likely to choose life-sustaining treatment, compared with whites, said Dr. Cintron, a physician in the department of geriatrics at Mount Sinai Medical Center, New York. His review of 12 studies that focused on hospice use identified factors that were linked with the lower level of hospice enrollment by African Americans. These factors were lack of knowledge, cost, communication barriers, and distrust of the health care system." @default.
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• W2078102717 date "2006-03-01" @default.
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• W2078102717 title "Racial Disparities Are Cited In Hospice Admissions Since 1999" @default.
• W2078102717 doi "https://doi.org/10.1016/s1526-4114(06)60064-4" @default.
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