Abstract: TH-PO648
Racial Differences in End-of-Life Care Among Older Veterans with Non-Dialysis-Dependent CKD
Session Information
- Geriatric Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1100 Geriatric Nephrology
Authors
- Eneanya, Nwamaka D., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Weissman, Gary E., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Courtright, Katherine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Reese, Peter P., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Dember, Laura M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Halpern, Scott D., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Cohen, Jordana B., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
Previous studies of veterans receiving dialysis demonstrated more intensive end-of-life (EOL) care among racial minorities than non-minorities. Little is known about racial differences in EOL care for older veterans with non-dialysis dependent chronic kidney disease (CKD).
Methods
We conducted a retrospective cohort study of veterans with incident stage 4 CKD from 2003-2014, age ≥70 years, and death before 1/18/17. Outcomes were a composite of intensive care (initiation of dialysis, invasive mechanical ventilation, cardiopulmonary resuscitation, or artificial nutrition) in the final month of life, and palliative care or hospice use in the final 6 months of life.
Results
21,165 decedents met inclusion criteria. Non-Hispanic Whites were more often married and less often had hypertension, diabetes, and dementia compared to Non-Hispanic Blacks or Hispanics. In adjusted analyses, Non-Hispanic Blacks (OR 1.69, 95% CI 1.46-1.95) and Hispanics (OR 2.23, 95% CI 1.87-2.67) had a higher likelihood of intensive care compared to Non-Hispanic Whites. There was a significant interaction between death year and race with regard to hospice or palliative care use (p<0.01): compared with Non-Hispanic Whites, minorities had a similar likelihood of palliative care or hospice use before 2010, but higher use in recent years (Figure).
Conclusion
Historically, Non-Hispanic Black and Hispanic older veterans with CKD experienced more EOL intensive care and similar hospice or palliative care use compared with Non-Hispanic Whites. Following recent Veterans Health Administration investments in palliative care, minorities were more likely than non-minorities to use palliative care or hospice. More research is needed to assess how health system factors contribute to racial differences in EOL care.
Funding
- NIDDK Support