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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