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Geographic variation in black-white differences in end-of-life care for patients with ESRD

TitleGeographic variation in black-white differences in end-of-life care for patients with ESRD
Publication TypeJournal Article
Year of Publication2013
AuthorsThomas, BA, Rodriguez, RA, Boyko, EJ, Robinson-Cohen, C, Fitzpatrick, AL, O'Hare, AM
JournalClin J Am Soc NephrolClin J Am Soc NephrolClin J Am Soc Nephrol
Date PublishedJul
ISBN Number1555-905X (Electronic)<br/>1555-9041 (Linking)
Accession Number23580783
KeywordsAfrican Americans/statistics & numerical data, Aged, Cohort Studies, Dialysis, European Continental Ancestry Group/statistics & numerical data, Female, Health Services Accessibility/ statistics & numerical data, Healthcare Disparities/ ethnology/statistics & numerical data, Hospice Care, Hospital Mortality/ethnology, Humans, Kidney Failure, Chronic/ethnology/mortality/ therapy, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Physician's Practice Patterns/statistics & numerical data, Referral and Consultation, Registries, Residence Characteristics/statistics & numerical data, Risk Assessment, Risk Factors, Terminal Care/statistics & numerical data, United States/epidemiology, Withholding Treatment
AbstractBACKGROUND AND OBJECTIVES: Patterns of end-of-life care among patients with ESRD differ by race. Whether the magnitude of racial differences in end-of-life care varies across regions is not known. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This observational cohort study used data from the US Renal Data System and regional health care spending patterns from the Dartmouth Atlas of Healthcare. The cohort included 101,331 black and white patients 18 years and older who initiated chronic dialysis or received a kidney transplant between June 1, 2005, and September 31, 2008, and died before October 1, 2009. Black-white differences in the odds of in-hospital death, dialysis discontinuation, and hospice referral by quintile of end-of-life expenditure index (EOL-EI) were examined. RESULTS: In adjusted analyses, the odds ratios for dialysis discontinuation for black versus white patients ranged from 0.47 (95% confidence interval=0.43 to 0.51) in the highest quintile of EOL-EI to 0.63 (95% confidence interval=0.54 to 0.74) in the lowest quintile (P for interaction
Short TitleClinical journal of the American Society of Nephrology : CJASN
Alternate JournalClinical journal of the American Society of Nephrology : CJASN
Ethno Med: