Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic veterans
Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic veterans
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DOI：
10.1016/s0027-9684(15)31442-5
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发表时间：
2008-09-01
影响因子：
3.3
通讯作者：
Morgan, Robert O.
中科院分区：
文献类型：
--
作者：
Braun, Ursula K.;McCullough, Laurence B.;Morgan, Robert O.
背景：没有关于临终患者使用干预措施的种族/民族差异的概念数据。目的：检验在患有癌症、非癌症或痴呆的住院重症退伍军人的3个队列中，常见维持生命治疗的使用是否因种族/民族而有显著差异。设计：1991-2002财政年度的回顾性队列研究。患者：住院退伍军人，年龄55岁以上，临床定义为6个月死亡率高危，非死者数据。测量：5种维持生命疗法的使用模式按种族/民族划分。Logistic回归模型评估了白种人、非洲裔美国人和西班牙裔美国人之间的差异，控制了年龄、疾病严重程度和退伍军人事务部（VA）医疗中心患者的聚类。结果：在166059名退伍军人中，发现了诊断队列之间的差异和共性。非裔美国人在各个疾病队列中接受了更多或相同数量的临终治疗，除了较少的复苏[or =0.84 (0.77-0.92), p=0.002]和机械通气[or =0.89 (0.85-0.94), p
Background: No notional data exist regarding racial/ethnic differences in the use of interventions for patients at the end of life.Objectives: To test whether among 3 cohorts of hospitalized seriously ill veterans with cancer, noncancer or dementia the use of common life-sustaining treatments differed significantly by race/ethnicity.Design: Retrospective cohort study during fiscal years 1991-2002.Patients: Hospitalized veterans >55 years, defined clinically as at high-risk for 6-month mortality, not by decedent data.Measurements: Utilization patterns by race/ethnicity for 5 life-sustaining therapies. Logistic regression models evaluated differences among Caucasians, African Americans and Hispanics, controlling for age, disease severity and clustering of patients within Veterans Affairs (VA) medical centers.Results: Among 166,059 veterans, both differences and commonalities across diagnostic cohorts were found. African Americans received more or the same amount of end-of-life treatments across disease cohorts, except for less resuscitation [OR=0.84 (0.77-0.92), p=0.002] and mechanical ventilation [OR=0.89 (0.85-0.94), p