Blacks More Likely To Leave Hospice For Life-Extending Treatment

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

End-of-Life Care

Blacks enrolled in ahospice program are more likely than whites to leave hospice to pursue life-extendingtreatment, according to a study published in the Archives of InternalMedicine, Reuters Health reports.

For the study, Kimberly Johnson of Duke University and colleagues looked at files of166,197 black and white patients who received care from VITAS, achain of hospice facilities. The study found that 2.8% of all patients lefthospice to pursue life-prolonging treatment. According to the study, blackswere 70% more likely than whites to leave hospice care to seek treatmentunavailable in a hospice. The study found that 4.5% of blacks left hospice toseek life-prolonging treatment, compared with 2.5% of whites.

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

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They added that "models of health care that couple curative and(supportive) therapies may be more attractive to African-American patients andmore effective at maximizing continuity throughout life-limiting illness"(Reuters Health, 1/31).

Sepsis

Compared with whites andHispanics, blacks are more likely to contract severe sepsis and die from it,according to a study published in the American Journal of Respiratory andCritical Care Medicine, the NewarkStar-Ledgerreports.

For the study, lead author Amber Barnato, an assistant professor of medicineand health policy and management at the University ofPittsburgh, andcolleagues looked at race-specific incidence and death rates in intensive careunits among sepsis patients in Florida, Massachusetts, New Jersey,New York, Virginiaand Texas.They also looked at socioeconomic and demographic data from the 2000 Census andcorresponding clinical hospital discharge data for sepsis cases treated in2001. 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 sepsisincidence and related death rates. Rates for Hispanics living in urban areaswere lower. Blacks were more likely than other groups to receive treatment forsepsis at large, urban teaching hospitals, which see a disproportionate numberof black patients. According to the study, such hospitals might have a lowerquality of care or treat patients who are sicker.

The study also indicates that socioeconomic factors, such as access to care andbehavior, might play a role in the disparate rates (Stewart, Newark Star-Ledger, 2/1).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Weekly HealthDisparities Report is published for kaisernetwork.org, a free service of TheHenry J. Kaiser Family Foundation.

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