Disparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-10 DOI:10.1111/jgs.19046

Miguel Cid MPH, Main Lin Quan Vega MD, Zhixin Yang MS, Jean Guglielminotti MD, PhD, Guohua Li MD, DrPH, May Hua MD, MS

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引用次数: 0

Abstract

Background

Racial and ethnic minorities often receive care at different hospitals than non-Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. The aim of this study was to determine if disparities in end-of-life care were present among minoritized patients during terminal hospitalizations, and if these disparities varied with hospital characteristics.

Methods

We identified hospitalizations where a patient died in New York State, 2016–2018. Using multilevel logistic regression, we examined whether documented end-of-life care (do-not-resuscitate status (DNR), palliative care (PC) encounter) differed by race and ethnicity, and whether these disparities differed based on receiving care in hospitals with varying characteristics (Black or Hispanic-serving hospital; teaching status; bed size; and availability of specialty palliative care).

Results

We identified 143,713 terminal hospitalizations in 188 hospitals. Across all hospitals, only Black patients were less likely to have a PC encounter (adjusted odds ratio (aOR) 0.83 [0.80–0.87]) or DNR status (aOR 0.91 [0.87–0.95]) when compared with non-Hispanic White patients, while Hispanic patients were more likely to have DNR status (aOR 1.07 [1.01–1.13]). In non-teaching hospitals, all minoritized groups had decreased odds of PC (aOR 0.80 [0.76–0.85] for Black, aOR 0.91 [0.85–0.98] for Hispanic, aOR 0.93 [0.88–0.98] for Others), while in teaching hospitals, only Black patients had a decreased likelihood of a PC encounter (aOR 0.88 [0.82–0.93]). Also, Black patients in a Black-serving hospitals were less likely to have DNR status (aOR 0.80 [0.73–0.87]). Disparities did not differ based on whether specialty PC was available (p = 0.27 for PC encounter, p = 0.59 for DNR status).

Conclusion

During terminal hospitalizations, Black patients were less likely than non-Hispanic White patients to have documented end-of-life care. This disparity appears to be more pronounced in non-teaching hospitals than in teaching hospitals.

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纽约州少数种族和族裔病人在临终住院期间的临终关怀差异。

背景：与非西班牙裔白人患者相比，少数种族和少数族裔患者通常在不同的医院接受治疗，但医院特征如何影响临终关怀差异的发生尚不清楚。本研究旨在确定在临终住院期间，少数族裔患者在临终护理方面是否存在差异，以及这些差异是否随医院特征而变化：我们确定了 2016-2018 年纽约州患者死亡的住院情况。利用多层次逻辑回归，我们研究了记录在案的临终关怀（拒绝复苏状态（DNR）、姑息治疗（PC））是否因种族和民族而异，以及这些差异是否因在具有不同特征的医院（黑人或西班牙裔服务医院；教学状态；床位规模；以及是否提供专业姑息治疗）接受治疗而异：我们在 188 家医院中发现了 143713 例临终住院病例。在所有医院中，与非西班牙裔白人患者相比，只有黑人患者不太可能遇到 PC（调整赔率比 (aOR) 0.83 [0.80-0.87] ）或 DNR 状态（aOR 0.91 [0.87-0.95]），而西班牙裔患者更有可能遇到 DNR 状态（aOR 1.07 [1.01-1.13]）。在非教学医院，所有少数族裔群体发生 PC 的几率都有所下降（黑人的 aOR 为 0.80 [0.76-0.85]，西班牙裔的 aOR 为 0.91 [0.85-0.98]，其他族裔的 aOR 为 0.93 [0.88-0.98]），而在教学医院，只有黑人患者发生 PC 的几率有所下降（aOR 为 0.88 [0.82-0.93]）。此外，在为黑人服务的医院中，黑人患者出现 DNR 状态的可能性较低（aOR 0.80 [0.73-0.87]）。差异并不因是否有专科 PC 而异（P = 0.27 for PC encounter，P = 0.59 for DNR status）：结论：在临终住院期间，黑人患者比非西班牙裔白人患者更不可能获得有记录的临终关怀。这种差异在非教学医院似乎比教学医院更为明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.