The Influence Of Race/Ethnicity And Socioeconomic Status On End-of-life Care In The Intensive Care Unit

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).