Racial disparities in intensity of care at the end-of-life: Are trauma patients the same as the rest?

Zara Cooper, Frederick P. Rivara, Jin Wang, Ellen J. Mackenzie, Gregory Jurkovich

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction. Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods. We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results. Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95% CI, 1.22, 2.30), specialty assessments RR=1.44 (95% CI, 1.12, 1.86) and procedures RR=1.22 (95% CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95% CI, 0.53, 0.98). Conclusion. Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.

Original languageEnglish (US)
Pages (from-to)857-874
Number of pages18
JournalJournal of Health Care for the Poor and Underserved
Volume23
Issue number2
DOIs
StatePublished - May 1 2012
Externally publishedYes

Fingerprint

Terminal Care
Hispanic Americans
Wounds and Injuries
Patient Preference
Hospital Costs
Health Resources
Critical Care
Medicare
Cohort Studies
Referral and Consultation
Prospective Studies
Delivery of Health Care
Therapeutics

Keywords

  • End-of-life care
  • Racial disparities
  • Treatment preferences

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Racial disparities in intensity of care at the end-of-life : Are trauma patients the same as the rest? / Cooper, Zara; Rivara, Frederick P.; Wang, Jin; Mackenzie, Ellen J.; Jurkovich, Gregory.

In: Journal of Health Care for the Poor and Underserved, Vol. 23, No. 2, 01.05.2012, p. 857-874.

Research output: Contribution to journalArticle

Cooper, Zara ; Rivara, Frederick P. ; Wang, Jin ; Mackenzie, Ellen J. ; Jurkovich, Gregory. / Racial disparities in intensity of care at the end-of-life : Are trauma patients the same as the rest?. In: Journal of Health Care for the Poor and Underserved. 2012 ; Vol. 23, No. 2. pp. 857-874.
@article{92b74153f8ed4beda0ba41ec7e575a46,
title = "Racial disparities in intensity of care at the end-of-life: Are trauma patients the same as the rest?",
abstract = "Introduction. Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods. We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results. Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95{\%} CI, 1.22, 2.30), specialty assessments RR=1.44 (95{\%} CI, 1.12, 1.86) and procedures RR=1.22 (95{\%} CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95{\%} CI, 0.53, 0.98). Conclusion. Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.",
keywords = "End-of-life care, Racial disparities, Treatment preferences",
author = "Zara Cooper and Rivara, {Frederick P.} and Jin Wang and Mackenzie, {Ellen J.} and Gregory Jurkovich",
year = "2012",
month = "5",
day = "1",
doi = "10.1353/hpu.2012.0064",
language = "English (US)",
volume = "23",
pages = "857--874",
journal = "Journal of Health Care for the Poor and Underserved",
issn = "1049-2089",
publisher = "Johns Hopkins University Press",
number = "2",

}

TY - JOUR

T1 - Racial disparities in intensity of care at the end-of-life

T2 - Are trauma patients the same as the rest?

AU - Cooper, Zara

AU - Rivara, Frederick P.

AU - Wang, Jin

AU - Mackenzie, Ellen J.

AU - Jurkovich, Gregory

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Introduction. Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods. We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results. Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95% CI, 1.22, 2.30), specialty assessments RR=1.44 (95% CI, 1.12, 1.86) and procedures RR=1.22 (95% CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95% CI, 0.53, 0.98). Conclusion. Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.

AB - Introduction. Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods. We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results. Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95% CI, 1.22, 2.30), specialty assessments RR=1.44 (95% CI, 1.12, 1.86) and procedures RR=1.22 (95% CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95% CI, 0.53, 0.98). Conclusion. Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.

KW - End-of-life care

KW - Racial disparities

KW - Treatment preferences

UR - http://www.scopus.com/inward/record.url?scp=84860459263&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860459263&partnerID=8YFLogxK

U2 - 10.1353/hpu.2012.0064

DO - 10.1353/hpu.2012.0064

M3 - Article

C2 - 22643629

AN - SCOPUS:84860459263

VL - 23

SP - 857

EP - 874

JO - Journal of Health Care for the Poor and Underserved

JF - Journal of Health Care for the Poor and Underserved

SN - 1049-2089

IS - 2

ER -