Disparities in end‐of‐life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State

• Published in: Journal of the American Geriatrics Society (JAGS) 2024-09, Vol.72 (9), p.2690-2699
• Main Authors: Cid, Miguel, Quan Vega, Main Lin, Yang, Zhixin, Guglielminotti, Jean, Li, Guohua, Hua, May
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Black or African American; end‐of‐life; Female; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hispanic or Latino; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Male; Middle Aged; minority‐serving hospitals; New York; Older people; Palliation; Palliative care; Palliative Care - statistics & numerical data; Patients; Resuscitation Orders; Teaching hospitals; Terminal Care - statistics & numerical data; White
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.19046

Background Racial and ethnic minorities often receive care at different hospitals than non‐Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. The aim of this study was to determine if disparities in end‐of‐life care were present among minoritized patients during terminal hospitalizations, and if these disparities varied with hospital characteristics. Methods We identified hospitalizations where a patient died in New York State, 2016–2018. Using multilevel logistic regression, we examined whether documented end‐of‐life care (do‐not‐resuscitate status (DNR), palliative care (PC) encounter) differed by race and ethnicity, and whether these disparities differed based on receiving care in hospitals with varying characteristics (Black or Hispanic‐serving hospital; teaching status; bed size; and availability of specialty palliative care). Results We identified 143,713 terminal hospitalizations in 188 hospitals. Across all hospitals, only Black patients were less likely to have a PC encounter (adjusted odds ratio (aOR) 0.83 [0.80–0.87]) or DNR status (aOR 0.91 [0.87–0.95]) when compared with non‐Hispanic White patients, while Hispanic patients were more likely to have DNR status (aOR 1.07 [1.01–1.13]). In non‐teaching hospitals, all minoritized groups had decreased odds of PC (aOR 0.80 [0.76–0.85] for Black, aOR 0.91 [0.85–0.98] for Hispanic, aOR 0.93 [0.88–0.98] for Others), while in teaching hospitals, only Black patients had a decreased likelihood of a PC encounter (aOR 0.88 [0.82–0.93]). Also, Black patients in a Black‐serving hospitals were less likely to have DNR status (aOR 0.80 [0.73–0.87]). Disparities did not differ based on whether specialty PC was available (p = 0.27 for PC encounter, p = 0.59 for DNR status). Conclusion During terminal hospitalizations, Black patients were less likely than non‐Hispanic White patients to have documented end‐of‐life care. This disparity appears to be more pronounced in non‐teaching hospitals than in teaching hospitals.