The Hospitals Minorities Commonly Visit Explain Their Greater Use of End-Of-Life Intensive Care
PITTSBURGH, December 21, 2006 — Although dying minority patients are more likely to use intensive care services than their white counterparts, that difference is mostly due to the particular hospitals that treat them rather than racial and ethnic disparities, according to a recent University of Pittsburgh study published in the December issue of Health Services Research.
One in five Americans die using intensive care services, consuming more than 80 percent of all terminal hospitalization costs. The study, which measured the ethnic and racial disparities of patients specifically in end-of-life intensive care, followed a different pattern than previous studies that compared patients who were in intensive care for non-terminal reasons. It found that although minorities, specifically African-Americans, receive less intensive care treatment than Caucasians for most medical services, African-American patients receive more intensive care treatment than Caucasian patients at the end of their lives.
Additionally, the study revealed that minorities often access different health care providers than Caucasians because of residential segregation, and these hospitals were found to have higher rates of intensive care use with dying patients than the predominantly Caucasian hospitals. Thus, the heavier use of intensive care treatment by minorities was related to the specific physicians and hospitals that the patients used rather than variations of race and ethnicity in the same hospital.
“We found that the higher rate of ICU use among minorities who die in the hospital was mostly attributable to their use of hospitals with higher end-of-life intensive care for all dying patients, including white patients,” said Amber Barnato, M.D., M.P.H., M.S., an assistant professor of the department of medicine and the department of health policy and management at the University of Pittsburgh School of Medicine and the University of Pittsburgh Graduate School of Public Health. “It could be that these higher intensity hospitals have a more intensive practice style, irrespective of patients’ wishes, or that these hospitals are responding to some community preferences for more intensive treatment that are shared across racial and ethnic groups, which seems much less likely.”
After comparing 1999 hospital discharge data for approximately 200,000 adults from non-federal hospitals in Florida, Massachusetts, New Jersey, New York and Virginia, researchers found that end-of-life ICU use was highest among minorities, varying from 64.4 percent among Hispanics, 64 percent among African-Americans and 57.5 percent among Caucasians. Statistically, racial and ethnic gaps among patients in end-of-life intensive care were much smaller when the particular hospitals that treated the patients were accounted for.
In addition to Dr. Barnato, other authors of this study were Derek Angus, M.D., vice chair of research in the department of critical care medicine; Chung Chou H. Chang, Ph.D.; Lisa A. Weissfeld, Ph.D., all of the University of Pittsburgh; Zekarias Berhane, Ph.D., of Drexel University; and Walter T. Linde-Zwirble, of consulting firm ZD Associates.
This study was supported by a grant from the Robert Wood Johnson Foundation to the ICU End-of-Life Peer Group as well as a career development award given to Dr. Barnato by the National Institute on Aging.
A copy of this study is available for review online at: http://www.blackwell-synergy.com/doi/full/10.1111/j.1475-6773.2006.00598.x.