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Does Admission to the ICU Prevent African American Disparities in Withdrawal of Life-Sustaining Treatment?

Chertoff, Jason MD, MPH; Olson, Angela MD; Alnuaimat, Hassan MD

doi: 10.1097/CCM.0000000000002478
Online Brief Reports

Objective: We sought to determine whether black patients admitted to an ICU were less likely than white patients to withdraw life-sustaining treatments.

Design: We performed a retrospective cohort study of hospital discharges from October 20, 2015, to October 19, 2016, for inpatients 18 years old or older and recorded those patients, along with their respective races, who had an “Adult Comfort Care” order set placed prior to discharge. A two-sample test for equality of two proportions with continuity correction was performed to compare the proportions between blacks and whites.

Setting: University of Florida Health.

Patients: The study cohort included 29,590 inpatient discharges, with 21,212 Caucasians (71.69%), 5,825 African Americans (19.69%), and 2,546 non-Caucasians/non–African Americans (8.62%).

Interventions: Withdrawal of life-sustaining treatments.

Measurements and Main Results: Of the total discharges (n = 29,590), 525 (1.77%) had the Adult Comfort Care order set placed. Seventy-eight of 5,825 African American patients (1.34%) had the Adult Comfort Care order set placed, whereas 413 of 21,212 Caucasian patients (1.95%) had this order set placed (p = 0.00251; 95% CI, 0.00248–0.00968). Of the 29,590 patients evaluated, 6,324 patients (21.37%) spent at least one night in an ICU. Of these 6,324 patients, 4,821 (76.24%) were white and 1,056 (16.70%) were black. Three hundred fifty of 6,324 (5.53%) were discharged with an Adult Comfort Care order set. Two hundred seventy-one White patients (5.62%) with one night in an ICU were discharged with an Adult Comfort Care order set, whereas 54 Black patients (5.11%) with one night in an ICU had the order set (p = 0.516).

Conclusions: This study suggests that Black patients may be less likely to withdraw life-supportive measures than whites, but that this disparity may be absent in patients who spend time in the ICU during their hospitalization.

All authors: Division of Pulmonary Critical Care, Department of Internal Medicine, University of Florida, Gainesville, FL.

Drs. Chertoff, Olson, and Alnuaimat contributed in the conception and design, analysis and interpretation, and drafting the article for important intellectual content.

The authors have disclosed that they do not have any potential conflicts of interest.

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