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Abstract: FR-PO905

Race, Ethnicity, and End-of-Life Care in US Dialysis Patients, 2000 to 2011

Session Information

Category: Dialysis

  • 609 Dialysis: Palliative and End-of-Life Care

Authors

  • Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
  • Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
  • Sexton, Donal J., The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin., Dublin, Ireland
  • Reule, Scott, University of Minnesota, Minneapolis, Minnesota, United States
Background

End-of-life care is an increasingly prominent consideration, especially in situations where death appears imminent and quality of life is poor. As little is known regarding potential racial and ethnic disparities, we performed a national study to determine whether end-of-life care in US dialysis patients was subject to racial or ethnic disparity.

Methods

Retrospective United States Renal Data System files were used to examine the primary outcome, a composite of withdrawal of dialysis and death in a non-hospital or hospice setting (2000 to 2011, N=910,559). The following racial-ethnic groups were examined: (non-Hispanic) white, African American, Native American, Asian; Hispanic. Logistic regression was used to calculate odds ratios for end-of-life care outcomes per race-ethnicity.

Results

The primary outcome was less likely in patients from any minority group (10.1%) than in the non-Hispanic white population (21.5%, P-Value < 0.001). Corresponding values for dialysis withdrawal, hospice and non-hospital death were 16.3% Vs. 30.8%, 8.8% Vs. 15.7% and 33.1% Vs. 45.0%, respectively (P-Value < 0.001 for each comparison). After extensive covariate adjustment, the primary outcome was less likely in the combined minority group than in the white population (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.53-0.53, P-Value < 0.001); within individual minority groups, AOR values arrayed as follows (Vs. white, P-Value < 0.001 for each): non-Hispanic Asian, AOR 0.43 (95% CI 0.41,0.46); non-Hispanic African American, AOR 0.48 (95% CI 0.47,0.49); non-Hispanic Native American, AOR 0.64 (95% CI 0.60, 0.68); Hispanic AOR 0.71 (95% CI 0.69,0.73). Minority-associated AORs for the primary outcome were < 1 in all 44 subgroups examined.

Conclusion

Compared to their non-Hispanic white counterparts, substantial, graded, unexplained disparities in end-of-life care practices appear to be present in all racial and ethnic minority groups.