Racial Disparities in Intensity of Care at the End-of-Life: Are Trauma Patients the Same as the Rest?

Introduction. Medicare data show Blacks and Hispanics use more health care resources in the last six months of life than Whites. We sought to determine if similar differences exist in trauma patients who died following moderate to severe injury. Methods. We analyzed data from a prospective cohort study of 18 Level 1 and 51 non-trauma centers in 12 states to examine racial/ethnic variation in intensity of care and hospital costs. Results. Blacks were more likely than Whites to receive critical care consultation RR=1.67 (95% CI, 1.22, 2.30), specialty assessments RR=1.44 (95% CI, 1.12, 1.86) and procedures RR=1.22 (95% CI, 1.00, 150). Hispanics were less likely than Whites to have withdrawal-of-care orders, RR=0.72 (95% CI, 0.53, 0.98). Conclusion. Among patients who die after trauma, Blacks receive higher intensity of care and Hispanics were less likely to have withdrawal of care orders than others. This suggests racial disparities in patient preferences and provider treatment.