Global Brain Health Institute (I.M.), University of California, San Francisco, CA, USA; Tel Aviv University Sackler School of Medicine (I.M.), Ramat Aviv, Israel.
Departments of Psychiatry and Behavioral Science (K.Y.), Neurology and Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA.
J Pain Symptom Manage. 2022 Sep;64(3):e109-e114. doi: 10.1016/j.jpainsymman.2022.05.010. Epub 2022 May 23.
Little is known about racial differences in place of death for persons with dementia (PWD), who may be especially vulnerable to receiving care at end of life that is not concordant with their goals or that places higher burden on caregivers.
To determine if there are racial and ethnic differences in place of death among PWD.
We analyzed data from the nationally representative National Health and Aging Trends study. Participants were included if they had probable dementia as defined by a previously validated algorithm and died between 2012 and 2020. Race and ethnicity were self-reported. Place of death was obtained from post-mortem interviews with bereaved caregivers.
The sample included 993 decedents with dementia (81.4% white; 11.0% black, 7.6% hispanic). A higher percentage of black and hispanic decedents died in the hospital (30.3% and 32.8%, respectively) compared to white decedents (19.0%). A higher percentage of white decedents died in the nursing home (31.0%) than black (22.4%) or hispanic decedents (15.0%) In adjusted analyses, black decedents had a higher odds of hospital death (AOR 1.50; 95% CI 1.01, 2.24) compared to white decedents, with similar trends found for hispanic decedents.
We found racial and ethnic differences in location of death for PWD, with black and hispanic PWD more likely to die in the hospital compared to white PWD. More research is needed to determine if the differences found represent goal concordant care or rather lack of access to high quality of care at the end of life.
对于患有痴呆症的人（PWD），他们在生命末期接受的护理可能与他们的目标不一致，或者给护理人员带来更高的负担，而关于他们死亡地点的种族差异知之甚少。
确定 PWD 的死亡地点是否存在种族和民族差异。
我们分析了全国代表性的国家健康与老龄化趋势研究的数据。参与者必须符合以下条件：根据先前验证的算法确定患有可能的痴呆症，并在 2012 年至 2020 年期间死亡。种族和民族是自我报告的。死亡地点是通过对失去亲人的护理人员进行的死后访谈获得的。
该样本包括 993 名患有痴呆症的死者（81.4%为白人；11.0%为黑人，7.6%为西班牙裔）。与白人死者（19.0%）相比，黑人（30.3%）和西班牙裔（32.8%）死者有更高的百分比死于医院。与黑人（22.4%）和西班牙裔（15.0%）死者相比，更多的白人死者（31.0%）死于养老院。在调整后的分析中，黑人死者在医院死亡的几率高于白人死者（AOR 1.50；95%CI 1.01，2.24），西班牙裔死者也有类似的趋势。
我们发现 PWD 死亡地点存在种族和民族差异，与白人 PWD 相比，黑人和西班牙裔 PWD 更有可能在医院死亡。需要进一步研究以确定发现的差异是否代表目标一致的护理，或者是否代表生命末期缺乏高质量的护理。
