ArticleJournal of palliative medicine2018
The Paradox of End-of-Life Hospital Treatment Intensity among Black Patients: A Retrospective Cohort Study.
Article in Journal of palliative medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
12 citing papers in PubMed.
- Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial.Critical care medicine · 2019Trial
- Racial, Ethnic, and Socioeconomic Differences in Critical Care Near the End of Life: A Narrative Review.Critical care clinics · 2024Review
- Racial Disparities in Health Beliefs and Advance Care Planning Among Patients Receiving Maintenance Dialysis.Journal of pain and symptom management · 2023Article
- A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead.Journal of pain and symptom management · 2022Review
- Advance Care Planning and Treatment Intensity Before Death Among Black, Hispanic, and White Patients Hospitalized with COVID-19.Journal of general internal medicine · 2022Article
- Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models.American journal of respiratory and critical care medicine · 2021Article
- Can primary palliative care education change life-sustaining treatment intensity of older adults at the end of life? A retrospective study.BMC palliative care · 2021Article
- Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer.Journal of pain and symptom management · 2021Article
- Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Observational
- End-of-life quality metrics among medicare decedents at minority-serving cancer centers: A retrospective study.Cancer medicine · 2020Article
- Measuring racial segregation in health system networks using the dissimilarity index.Social science & medicine (1982) · 2019Article
- Regional Practice Patterns and Racial/Ethnic Differences in Intensity of End-of-Life Care.Health services research · 2018Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveBlack patients are more likely than white patients to die in the hospital with intensive care and life-sustaining treatments and less likely to use hospice. Regional concentration of high end-of-life (EOL) treatment intensity practice patterns may disproportionately affect black patients. We calculated and compared race-specific hospital-level EOL treatment intensity in Pennsylvania.
methodsWe conducted a retrospective cohort analysis of Pennsylvania acute care hospital admissions, 2001-2007, among black and white admissions ≥21 years old at high probability of dying (HPD) (≥15% predicted probability of dying at admission). We calculated hospitals' race-specific observed, expected, and Bayes' shrunken observed-to-expected ratios of intensive care unit (ICU) admission, ICU length of stay (LOS), intubation/mechanical ventilation, hemodialysis, tracheostomy, and gastrostomy among HPD admissions; and an empirically weighted EOL treatment intensity index summing these ratios.
resultsThere were 35,609 black HPD admissions (27,576 unique patients) and 311,896 white HPD admissions (252,662 unique patients) to 182 hospitals. Among 95 hospitals with ≥30 black HPD admissions, 80% of black admissions were concentrated in 29 hospitals, where black-specific observed and expected EOL measures were usually higher than white-specific measures (p < 0.001 for all but 5/24 measures). Hospitals' black-specific and white-specific observed-to-expected ratios of ICU and life-sustaining treatment (LST) (rho 0.52-0.90) and EOL index (rho = 0.92) were highly correlated. However, black-specific observed-to-expected ratios and overall EOL intensity index were consistently lower than white-specific ratios (p < 0.001 for all except hemodialysis).
conclusionsIn Pennsylvania, black-serving hospitals have higher standardized EOL treatment intensity than nonblack-serving hospitals, contributing to black patients' relatively higher use of intensive treatment. However, conditional on being admitted to the same high-intensity hospital and after risk adjustment, blacks are less intensively treated than whites.
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