Racial/ethnic disparities in hospital utilization in intracerebral hemorrhage

Abstract

Background and purpose There is evidence that racial and ethnic differences among intracerebral hemorrhage (ICH) patients exist. We sought to establish the occurrence of disparities in hospital utilization in the United States. Methods We identified ICH patients from United States Nationwide Inpatient Sample database for years 2006–2014 using codes (DX1 = 431, 432.0) from the International Classification of Diseases, 9th edition. We compared five race/ethnic categories: White, Black, Hispanic, Asian or Pacific Islander, and Others ( Native American and other) with regard to demographics, comorbidities, disease severity, in-hospital complications, in-hospital procedures, length of stay (LOS), total hospital charges, in-hospital mortality, palliative care, (PC) and do not resuscitate (DNR). We categorized procedures as lifesaving (i.e. ventriculostomy, craniotomy, craniectomy, and ventriculoperitoneal (VP) shunt), life sustaining (i.e. mechanical ventilation, tracheostomy, transfusions, and gastrostomy). White race/ethnicity was set as the reference group. Results Out of 710,293 hospitalized patients with ICH 470,539 (66.2%), 114,821 (16.2%), 66,451 (9.3%), 30,297 (4.3%) and 28,185 (3.9%) were White, Black, Hispanic, Asian or Pacific Islander, and Others, respectively. Minorities (Black, Hispanic, Asian or Pacific Islander, and Others) had a higher rate of in-hospital complications, in-hospital procedures, mean LOS, and hospital charges compared to Whites. In contrast, Whites had a higher rate of in-hospital mortality, PC, and DNR. In multivariable analysis, all minorities had higher rate of MV, tracheostomy, transfusions, and gastrostomy compared to Whites, while Hispanics had higher rate of craniectomy and VP shunt; and Asian or Pacific Islander and Others had higher rate of craniectomy. Whites had a higher rate of in-hospital mortality, palliative care, and DNR compared to minorities. In mediation analysis, in-hospital mortality for whites remained high after adjusting with PC and DNR. Conclusion Minorities had greater utilization of lifesaving and life sustaining procedures, and longer LOS. Whites had greater utilization of palliative care, hospice, and higher in-hospital mortality. These results may reflect differences in culture or access to care and deserve further study.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…40 Another study that identified 710,293 hospitalized intracerebral hemorrhage patients from the United States Nationwide Inpatient Sample database for the years 2006-2014 revealed that Hispanic Whites had greater utilization of palliative care, and hospice than non-Hispanic Blacks. 39 Furthermore, a retrospective study revealed considerable racial/ethnic disparities in the quality of palliative and endof-life care. Minorities were more likely than non-Hispanic Whites to experience potentially preventable medical encounters in the last month of life.…”

“…After searching almost fourthly-thousand citations, 284 articles were included in our study, of which 147 were manuscripts that directly addressed end-of-life and hospice care, palliative care, as well as advance care planning and directives that include non-Hispanic Blacks. 4 …”

“…Overwhelming evidence, based on large national data sets, consistently and unequivocally points to major disparities in palliative care in the United States. 13 , 39 , 40 , 55 , 64 One retrospective cohort study of over 5 million hospitalizations of dialysis patients revealed that non-Hispanic Black and Hispanic patients were less likely than non-Hispanic White patients to receive palliative care services in the hospital. This disparity was observed in all hospital subtypes, even hospitals with a high proportion of minority patients.…”

“… 40 Another study that identified 710,293 hospitalized intracerebral hemorrhage patients from the United States Nationwide Inpatient Sample database for the years 2006–2014 revealed that Hispanic Whites had greater utilization of palliative care, and hospice than non-Hispanic Blacks. 39 …”

“…Despite gains in the availability and acceptance of hospice care, non-Hispanic Blacks remain underrepresented among hospice clients. 11 , 19 , 39 , 75 , 101 , 141 , 142 , 146 , 173 , 174 It has been suggested that hospice care emphasizing family-centered care and spiritual support can be an excellent fit for non-Hispanic Blacks who are terminally ill. However, overwhelming evidence shows that non-Hispanic Blacks use hospice services at an appreciably lower rate than their non-Hispanic White counterparts.…”