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Advance Care Planning and Treatment Intensity Before Death Among Black, Hispanic, and White Patients Hospitalized with COVID-19.
- Source :
-
Journal of general internal medicine [J Gen Intern Med] 2022 Jun; Vol. 37 (8), pp. 1996-2002. Date of Electronic Publication: 2022 Apr 11. - Publication Year :
- 2022
-
Abstract
- Background: Black and Hispanic people are more likely to contract COVID-19, require hospitalization, and die than White people due to differences in exposures, comorbidity risk, and healthcare access.<br />Objective: To examine the association of race and ethnicity with treatment decisions and intensity for patients hospitalized for COVID-19.<br />Design: Retrospective cohort analysis of manually abstracted electronic medical records.<br />Patients: 7,997 patients (62% non-Hispanic White, 16% non-Black Hispanic, and 23% Black) hospitalized for COVID-19 at 135 community hospitals between March and June 2020 MAIN MEASURES: Advance care planning (ACP), do not resuscitate (DNR) orders, intensive care unit (ICU) admission, mechanical ventilation (MV), and in-hospital mortality. Among decedents, we classified the mode of death based on treatment intensity and code status as treatment limitation (no MV/DNR), treatment withdrawal (MV/DNR), maximal life support (MV/no DNR), or other (no MV/no DNR).<br />Key Results: Adjusted in-hospital mortality was similar between White (8%) and Black patients (9%, OR=1.1, 95% CI=0.9-1.4, p=0.254), and lower among Hispanic patients (6%, OR=0.7, 95% CI=0.6-1.0, p=0.032). Black and Hispanic patients were significantly more likely to be treated in the ICU (White 23%, Hispanic 27%, Black 28%) and to receive mechanical ventilation (White 12%, Hispanic 17%, Black 16%). The groups had similar rates of ACP (White 12%, Hispanic 12%, Black 11%), but Black and Hispanic patients were less likely to have a DNR order (White 13%, Hispanic 8%, Black 7%). Among decedents, there were significant differences in mode of death by race/ethnicity (treatment limitation: White 39%, Hispanic 17% (p=0.001), Black 18% (p<0.0001); treatment withdrawal: White 26%, Hispanic 43% (p=0.002), Black 28% (p=0.542); and maximal life support: White 21%, Hispanic 26% (p=0.308), Black 36% (p<0.0001)).<br />Conclusions: Hospitalized Black and Hispanic COVID-19 patients received greater treatment intensity than White patients. This may have simultaneously mitigated disparities in in-hospital mortality while increasing burdensome treatment near death.<br /> (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Details
- Language :
- English
- ISSN :
- 1525-1497
- Volume :
- 37
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of general internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 35412179
- Full Text :
- https://doi.org/10.1007/s11606-022-07530-4