Sociodemographic factors and the assignment of do-not-resuscitate orders in patients with acute myocardial infarctions

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives. This study examined the impact of sociodemographic and clinical factors, measured at the individual or ecological (zip code) level, on the assignment of do-not-resuscitate (DNR) orders. Design. This was a retrospective study (analysis of secondary data). Subjects. We used a probability sample of 974 patients admitted to 30 medium to large California hospitals with acute myocardial infarctions in 1990 to 1991; the sample was originally designed to validate risk adjustment with administrative data. Methods. Multivariate logistic regression was used to adjust DNR assignment for age, gender, race, probability of death, functional impairments, payment source, hospital teaching status, and ecological measures of educational attainment, home ownership, and income. Results. DNR assignment was inversely associated with black race and positively associated with age, probability of death, cognitive impairment, and poor nutritional status. When the probability of death was very low, DNR orders were assigned less frequently to men than to women (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2 to 0.7 at probability of death = 0.10). However, men were significantly more likely to receive a DNR order than women when the probability of death was very high (OR, 4.4; 95% CI, 1.2 to 16.3 at probability of death = 0.90). Conclusions. Older, white, sicker, or functionally impaired patients receive DNR orders more often than younger, black, healthier, or functionally intact patients do. Adjusting for these factors, DNR assignment is associated with gender through an interaction involving the probability of death. Future studies should reexamine the impact of these factors on DNR assignment and explore the role of patient values and patient-physician communication barriers.

Original languageEnglish (US)
Pages (from-to)670-678
Number of pages9
JournalMedical Care
Volume38
Issue number6
StatePublished - Jun 2000

Fingerprint

Resuscitation Orders
sociodemographic factors
Myocardial Infarction
death
Odds Ratio
Confidence Intervals
Communication Barriers
confidence
Risk Adjustment
communication barrier
Sampling Studies
risk adjustment
Ownership
Nutritional Status
gender
Teaching Hospitals
Retrospective Studies
Logistic Models
Physicians
logistics

Keywords

  • Acute myocardial infarction
  • Advance directives
  • Do not resuscitate
  • Gender
  • Race

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

@article{c8c84eb33157497eaafc2cf1c52a527d,
title = "Sociodemographic factors and the assignment of do-not-resuscitate orders in patients with acute myocardial infarctions",
abstract = "Objectives. This study examined the impact of sociodemographic and clinical factors, measured at the individual or ecological (zip code) level, on the assignment of do-not-resuscitate (DNR) orders. Design. This was a retrospective study (analysis of secondary data). Subjects. We used a probability sample of 974 patients admitted to 30 medium to large California hospitals with acute myocardial infarctions in 1990 to 1991; the sample was originally designed to validate risk adjustment with administrative data. Methods. Multivariate logistic regression was used to adjust DNR assignment for age, gender, race, probability of death, functional impairments, payment source, hospital teaching status, and ecological measures of educational attainment, home ownership, and income. Results. DNR assignment was inversely associated with black race and positively associated with age, probability of death, cognitive impairment, and poor nutritional status. When the probability of death was very low, DNR orders were assigned less frequently to men than to women (odds ratio [OR], 0.4; 95{\%} confidence interval [CI], 0.2 to 0.7 at probability of death = 0.10). However, men were significantly more likely to receive a DNR order than women when the probability of death was very high (OR, 4.4; 95{\%} CI, 1.2 to 16.3 at probability of death = 0.90). Conclusions. Older, white, sicker, or functionally impaired patients receive DNR orders more often than younger, black, healthier, or functionally intact patients do. Adjusting for these factors, DNR assignment is associated with gender through an interaction involving the probability of death. Future studies should reexamine the impact of these factors on DNR assignment and explore the role of patient values and patient-physician communication barriers.",
keywords = "Acute myocardial infarction, Advance directives, Do not resuscitate, Gender, Race",
author = "Garcia, {Jorge A} and Romano, {Patrick S} and Chan, {Benjamin K S} and Kass, {Philip H} and Robbins, {John A}",
year = "2000",
month = "6",
language = "English (US)",
volume = "38",
pages = "670--678",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Sociodemographic factors and the assignment of do-not-resuscitate orders in patients with acute myocardial infarctions

AU - Garcia, Jorge A

AU - Romano, Patrick S

AU - Chan, Benjamin K S

AU - Kass, Philip H

AU - Robbins, John A

PY - 2000/6

Y1 - 2000/6

N2 - Objectives. This study examined the impact of sociodemographic and clinical factors, measured at the individual or ecological (zip code) level, on the assignment of do-not-resuscitate (DNR) orders. Design. This was a retrospective study (analysis of secondary data). Subjects. We used a probability sample of 974 patients admitted to 30 medium to large California hospitals with acute myocardial infarctions in 1990 to 1991; the sample was originally designed to validate risk adjustment with administrative data. Methods. Multivariate logistic regression was used to adjust DNR assignment for age, gender, race, probability of death, functional impairments, payment source, hospital teaching status, and ecological measures of educational attainment, home ownership, and income. Results. DNR assignment was inversely associated with black race and positively associated with age, probability of death, cognitive impairment, and poor nutritional status. When the probability of death was very low, DNR orders were assigned less frequently to men than to women (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2 to 0.7 at probability of death = 0.10). However, men were significantly more likely to receive a DNR order than women when the probability of death was very high (OR, 4.4; 95% CI, 1.2 to 16.3 at probability of death = 0.90). Conclusions. Older, white, sicker, or functionally impaired patients receive DNR orders more often than younger, black, healthier, or functionally intact patients do. Adjusting for these factors, DNR assignment is associated with gender through an interaction involving the probability of death. Future studies should reexamine the impact of these factors on DNR assignment and explore the role of patient values and patient-physician communication barriers.

AB - Objectives. This study examined the impact of sociodemographic and clinical factors, measured at the individual or ecological (zip code) level, on the assignment of do-not-resuscitate (DNR) orders. Design. This was a retrospective study (analysis of secondary data). Subjects. We used a probability sample of 974 patients admitted to 30 medium to large California hospitals with acute myocardial infarctions in 1990 to 1991; the sample was originally designed to validate risk adjustment with administrative data. Methods. Multivariate logistic regression was used to adjust DNR assignment for age, gender, race, probability of death, functional impairments, payment source, hospital teaching status, and ecological measures of educational attainment, home ownership, and income. Results. DNR assignment was inversely associated with black race and positively associated with age, probability of death, cognitive impairment, and poor nutritional status. When the probability of death was very low, DNR orders were assigned less frequently to men than to women (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2 to 0.7 at probability of death = 0.10). However, men were significantly more likely to receive a DNR order than women when the probability of death was very high (OR, 4.4; 95% CI, 1.2 to 16.3 at probability of death = 0.90). Conclusions. Older, white, sicker, or functionally impaired patients receive DNR orders more often than younger, black, healthier, or functionally intact patients do. Adjusting for these factors, DNR assignment is associated with gender through an interaction involving the probability of death. Future studies should reexamine the impact of these factors on DNR assignment and explore the role of patient values and patient-physician communication barriers.

KW - Acute myocardial infarction

KW - Advance directives

KW - Do not resuscitate

KW - Gender

KW - Race

UR - http://www.scopus.com/inward/record.url?scp=0034199910&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034199910&partnerID=8YFLogxK

M3 - Article

C2 - 10843314

AN - SCOPUS:0034199910

VL - 38

SP - 670

EP - 678

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 6

ER -