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• W2131002307 abstract "RATIONALE: There is conflicting evidence concerning the influence of race/ethnicity on utilization of intensive care at the end-of-life and little is known about the influence of socioeconomic status. METHODS: We examined patients dying in the ICU in 15 hospitals. Race/ethnicity was assessed as white and non-white. Socioeconomic status included patient education, health insurance, and income by zip code. To explore differences in end-of-life care, we examined use of 1) advance directives; 2) life-sustaining therapies; 3) symptom management; 4) communication; and 5) support services. RESULTS: Medical charts were abstracted for 3138/3400 patients of whom 2,479 (79%) were white and 659 (21%) were non-white (or Hispanic). In logistic regressions adjusted for patient demographics, socioeconomic factors and site, non-white patients were less likely to have living wills (OR 0.41, 95%CI=0.32-0.54), and more likely to die with full support (OR 1.59, 95%CI=1.30-1.94). In documentation of family conferences, nonwhite patients were more likely to have documentation that prognosis was discussed (OR 1.47, 95%CI=1.21-1.77) and that physicians recommended withdrawal of life support (OR 1.57, 95%CI=1.11-2.21). Non-whites were also more likely to have discord documented among family or with clinicians (OR 1.49, 95% CI=1.04-2.15). Socioeconomic status did not modify these associations and was not a consistent predictor of end-of-life care. CONCLUSIONS: We found numerous racial/ethnic differences in end-of-life care in the ICU that were not influenced by socioeconomic status. These differences could be due to Page 2 of 29 Copyright © 2011 American College of Chest Physicians at University of Washington on February 5, 2011 chestjournal.chestpubs.org Downloaded from treatment preferences, disparities, or both. Improving ICU end-of-life care for all patients and families will require better understanding of these issues. Abstract Word Count: 250Word Count: 250 How does this advance the field? (in 60 words) Recent studies show important differences in the care patients receive in the ICU based on patient race/ethnicity, but there are limited data about racial/ethnic differences in end-of-life care in the ICU or whether such differences are confounded by socioeconomic status. We found numerous racial/ethnic differences in end-of-life care in the ICU that were not influenced by socioeconomic status. These differences could be due to treatment preferences, disparities, or both. What are the clinical implications? (in 60 words) Our findings suggest important differences in the care patients receive at the end of life in the ICU. Improving ICU end-of-life care for all patients and families will require better understanding of these issues. Page 3 of 29 Copyright © 2011 American College of Chest Physicians at University of Washington on February 5, 2011 chestjournal.chestpubs.org Downloaded from INTRODUCTION A growing body of evidence demonstrates the existence of important racial and ethnic differences in healthcare. Although there are many studies reporting on disparities in healthcare in acute and chronic conditions, 1-5 there are relatively few studies that address racial disparities in the intensive care unit (ICU) and those report conflicting findings. Some have reported that African-American patients receive fewer medical interventions, 6,7 have shorter lengths of stay, and use fewer resources. 7 In contrast, others have found increased resource utilization including larger numbers of ICU admissions and higher numbers of medical interventions for minorites as compared to white patients. 8,9 Importantly, the ICU is a common site for the delivery of end-of-life care, with approximately one in five deaths in the U.S. occurring in or shortly after a stay in the ICU. 10 Differences in end-of-life care within the ICU setting may be the result of healthcare disparities, but may also be due to other factors, such as treatment preferences, that are different across racially and ethnically diverse groups. 11-13 There is evidence of disparities in end-of-life care, with racial minorities receiving lower quality of care than whites. 14,15 Eliminating racial and ethnic disparities in end-of-life care will require a better understanding of the sources of these differences. 1 We hypothesized that a better understanding of differences in end-of-life care in the ICU may help inform the discrepancies previously reported in the literature regarding racial and ethnic differences in ICU care and guide future research to identify, understand, and eliminate disparities. Page 4 of 29 Copyright © 2011 American College of Chest Physicians at University of Washington on February 5, 2011 chestjournal.chestpubs.org Downloaded from A critical confounder in the study of racial and ethnic differences in healthcare is the influence of socioeconomic status. Independent of racial and ethnic differences, socioeconomic status, as measured by income, education or insurance status, significantly impacts healthcare delivery. 16-18 For example, a recent systematic review found that uninsured patients were less likely to receive critical care services and, once in the ICU, were less likely to receive invasive procedures and more likely to have life support withdrawn. 18 Another important potential confounder is differences in care across different hospitals, since prior research has shown that some of the differences attributed to patient race/ethnicity are actually due to differences in quality of care among hospitals. 8 Therefore, when investigating racial and ethnic disparities in healthcare, it is important to consider the influence of socioeconomic status and to adjust for hospital effects. In this study of end-of-life care in the ICU, we examined three questions: 1) are race/ethnicity alone associated with end-of-life care provided to patients that die in the ICU or shortly after a stay in the ICU; 2) does socioeconomic status as measured by education, income and insurance status, alter the associations between race/ethnicity and end-of-life care; and 3) is socioeconomic status associated with end-of-life care after adjusting for patient race/ethnicity? Page 5 of 29 Copyright © 2011 American College of Chest Physicians at University of Washington on February 5, 2011 chestjournal.chestpubs.org Downloaded from" @default.
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• W2131002307 date "2010-05-01" @default.
• W2131002307 modified "2023-09-27" @default.
• W2131002307 title "The Influence Of Race/Ethnicity And Socioeconomic Status On End-of-life Care In The Intensive Care Unit" @default.
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• W2131002307 doi "https://doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6695" @default.
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