Health treatment for blacks often different than whites at end of life

  • Black patients in hospice are more likely to be admitted to the hospital, go to an emergency department or disenroll from hospice than whites, a new study found.
  • A researcher said that is worrisome because people go into hospice to receive end-of-life care, not life-prolonging treatment.
  • Another new report found higher rates of discrimination among older blacks receiving treatment for chronic conditions than among whites.
A patient is monitored in an examination room inside the Clinical Decision Unit at Kaiser Permanente's Capitol Hill Medical Center in Washington, D.C.
Brooks Kraft LLC | Corbis | Getty Images
A patient is monitored in an examination room inside the Clinical Decision Unit at Kaiser Permanente's Capitol Hill Medical Center in Washington, D.C.

Two news studies have found that health treatment for African-Americans is often different than whites when they are dying, and that blacks report higher rates of what they believe to be discrimination when being treated for chronic diseases.

The first study, released Monday in the Journal of the American Geriatrics Society, looked at the experiences of patients in hospice, or care for those with terminal illnesses.

Black hospice patients were significantly more likely than white patients to be admitted to a hospital, go to an emergency department and to disenroll from hospice prior to death, the study found.

Melissa Aldridge, one of the authors of the study, said that is worrisome, because hospice as a rule is designed to make patients comfortable as they head toward death, not temporarily prevent it from happening, as care in a hospital may do.

Aldridge said it is to be expected that some hospice patients will need to go to a hospital or emergency room for treatment. And she said there is wide variation between different providers of hospice in rates of hospital and ED admissions for their patients.

"Some of close to zero percent, some have 50 percent," said Aldridge, associate professor and vice chair for research in geriatrics and palliative medicine at the Icahn School of Medicine at the Mount Sinai Health System in New York.

But even after accounting for patient illnesses, demographics and the type of hospice, the study found there was a marked disparity between the experience of black and white patients, according to Aldridge.

The study found that 14.9 percent for blacks in hospice care were admitted to a hospital, compared with 8.7 percent for whites.

And 19.8 percent of black hospice patients went to an emergency department, compared with 13.5 percent of whites.

While 13 percent of whites disenrolled in hospice care, 18.1 percent of blacks did so, the study found.

The study's authors noted that the data they examined did not allow them to identify the reasons that patients went to the hospital or disenrolled in hospice.

But they said those actions could occur because of prefences by the patient or family members, as well as how the role of hospice care had been explained to a patient, in addition to burnout of caregivers.

The other study, by researchers at the University of California, San Francisco, Stanford University and UC Berkeley, looked at discrimination experienced by older patients with chronic diseases from 2008 through 2014.

Researchers found that there was a significant decline in the amount of discrimination reported by black patients during the six-year period, according to the study published in the Journal of General Internal Medicine.

In 2008, 27 percent of blacks reported receiving poorer service or treatment from doctors or hospitals based on what they believed to be discrimination, according to the study. That dropped to 21 percent in 2010, and to 20 percent by 2014.

Despite that decrease, blacks remained more likely than white patients to report a difference in treatment or service that they believed was driven by discrimination.

Eighteen percent of white patients reported discrimination in 2008, and by 2014, that had dropped only to 17 percent of whites, according to the research.

"In line with previous research, the current study found that socio-economic status interacted with reported discrimination in different ways for Whites than it did for Blacks," UC San Francisco said in a summary of the results.

"The wealthier they were, the less likely Whites in the study became to report discrimination of any kind, but this was not true for Blacks, who reported the same amount of discrimination regardless of wealth."

One of the researchers said that if patients believe they are getting unfair treatment by health providers, that could affect their willingness to get treatment and their adherence to treatment, "and thereby affect their health."

"It's still very common, and there's a long way to go," said that researcher, Thu Nguyen of UCSF.