End-of-life hospitalization for African American and non-Latino white nursing home residents: variation by race and a facility's racial composition

J Palliat Med. 2005 Feb;8(1):58-68. doi: 10.1089/jpm.2005.8.58.


Background: Hospitalization of nursing home residents at the end of life is common, more so among African Americans. Whether a nursing home's racial mix is associated with hospitalization is unknown.

Objective: This study examined the association between race, a nursing home's racial mix, and end-of-life hospitalization.

Design: This was a retrospective cohort study.

Setting/subjects: Studied were nursing home residents in New York (n = 14,159) and Mississippi (n = 1481) who died in 1995-1996 and had a minimum data set (MDS) assessment within 120 days of death.

Measurements: The outcome measure was the odds of hospitalization in the last 90 days of life. A variable reflecting a nursing home's proportion of African American residents (in 1995-1996) represented a nursing home's racial mix.

Results: Forty-six percent of African Americans and 32% of whites were hospitalized in the last 90 days of life. After controlling for demographics, diagnoses, function, patient preferences (do-not-resuscitate [DNR]), and facility resources, nursing home residents in facilities having higher proportions of African American residents had greater odds of hospitalization (adjusted odds ratio [AOR] 1.14; 95% confidence interval [CI] 1.10, 1.18 in New York and AOR 1.35; 95% CI 1.24, 1.46 in Mississippi). Age and frailty interacted with race; older African Americans had a 16% greater likelihood (95% CI 1.08, 1.24) of hospitalization, and African Americans with more functional limitations had a 37% (95% CI 1.24, 1.51) greater likelihood of hospitalization than did comparable whites.

Conclusions: It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans
  • Aged
  • Aged, 80 and over
  • European Continental Ancestry Group
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Mississippi
  • New York
  • Nursing Homes*
  • Patient Transfer / statistics & numerical data*
  • Retrospective Studies
  • Terminally Ill / statistics & numerical data*
  • United States