Blacks More Likely to Leave Hospice for Life-extending Treatment Than Whites

News sources covered two recently published studies on end-of-life care and sepsis among minorities. Summaries of the coverage appear below.

End-of-Life Care

Blacks enrolled in a hospice program are more likely than whites to leave hospice to pursue life-extending treatment, according to a study published in the Archives of Internal Medicine, Reuters Health reports.

For the study, Kimberly Johnson of Duke University and colleagues looked at files of 166,197 black and white patients who received care from VITAS, a chain of hospice facilities. The study found that 2.8% of all patients left hospice to pursue life-prolonging treatment. According to the study, blacks were 70% more likely than whites to leave hospice care to seek treatment unavailable in a hospice. The study found that 4.5% of blacks left hospice to seek life-prolonging treatment, compared with 2.5% of whites.

Previous research has indicated that blacks are much less likely than whites to enter a hospice and more likely to request life-sustaining treatment at the end of life. According to the study authors, "These beliefs and values that emphasize longevity and deny death" clash with the hospice philosophy. A lack of understanding hospice services, which emphasize care rather than cure, might be more common among black patients, the study authors said.

They added that "models of health care that couple curative and (supportive) therapies may be more attractive to African-American patients and more effective at maximizing continuity throughout life-limiting illness".

Sepsis

Compared with whites and Hispanics, blacks are more likely to contract severe sepsis and die from it, according to a study published in the American Journal of Respiratory and Critical Care Medicine, the Newark Star-Ledger reports.

For the study, lead author Amber Barnato, an assistant professor of medicine and health policy and management at the University of Pittsburgh, and colleagues looked at race-specific incidence and death rates in intensive care units among sepsis patients in Florida, Massachusetts, New Jersey, New York, Virginia and Texas. They also looked at socioeconomic and demographic data from the 2000 Census and corresponding clinical hospital discharge data for sepsis cases treated in 2001.

Researchers linked the data at the ZIP code level and adjusted for sex, age and type of location.

According to the study, blacks living in urban areas had the highest sepsis incidence and related death rates. Rates for Hispanics living in urban areas were lower. Blacks were more likely than other groups to receive treatment for sepsis at large, urban teaching hospitals, which see a disproportionate number of black patients. According to the study, such hospitals might have a lower quality of care or treat patients who are sicker.

The study also indicates that socioeconomic factors, such as access to care and behavior, might play a role in the disparate rates.

Source-Kaiser Family Foundation
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