At the end of life, black patients with kidney failure who receive chronic dialysis are less likely to be referred to hospice and to discontinue dialysis compared with white patients, according to a study.
Racial differences in care especially are pronounced in parts of the country that spend the most on end-of-life care, researchers reported.
There are known racial differences in aspects of kidney health such as access to transplantation and pre-dialysis kidney care, and health and survival during kidney disease and after kidney transplantation, according to background information in the study, which was published April 11 on the website of the Clinical Journal of the American Society of Nephrology.
Racial differences in patterns of end-of-life care generally have received much less attention, although studies indicate that black patients with kidney failure are less likely to be referred to hospice, less likely to discontinue dialysis and more likely to receive intensive interventions such as ICU admission at the very end of life.
Most prior studies describing racial differences in patterns of end-of-life care have not examined whether the magnitude of these differences is uniform across different regions of the country. To investigate, Bernadette Thomas, MD, of the University of Washington in Seattle, and her colleagues examined data from the United States Renal Data System on 101,331 black and white adult patients who initiated chronic dialysis or received a kidney transplant between 2005 and 2008 and died before Oct. 1, 2009. The investigators also analyzed regional healthcare spending patterns from the Dartmouth Atlas of Healthcare.
Similar to other studies, the researchers found large racial differences in rates of hospice referral and dialysis discontinuation. However, when black and white patients were examined separately, the investigators also observed large differences in the frequency of hospice referral and dialysis discontinuation between high- and low-spending regions. The racial disparities were greatest in the highest-spending regions, according to the researchers analysis.
In the highest-spending regions, for example, black patients were 47% as likely as white patients to have dialysis discontinuation, compared with a 63% relative likelihood in lowest-spending regions.
Black patients chances of receiving hospice referral were 55% compared with white patients in the highest-spending regions, and 82% in the lowest-spending regions.
“There are pronounced black-white differences in patterns of hospice referral and dialysis discontinuation among patients with ESRD that vary substantially across regions of the United States,” the researchers concluded.
The study is available at http://cjasn.asnjournals.org/content/early/2013/04/09/CJN.06780712.full.