Ethnicity and end-of-life care: the use of feeding tubes

BACKGROUND: Blacks utilize many health care services at lower rates than do Whites. However, in end-of-life care, the situation is frequently reversed, with Blacks using life-sustaining interventions at higher rates than do Whites. We investigated the use of feeding tubes in very severely cognitively impaired nursing-home residents, and examined the findings in light of previous studies on the role of ethnicity in end-of-life decision making. DESIGN AND METHODS: We performed a descriptive, cross-sectional population-based study of residents in Kansas nursing homes from January 1994 through June 1998, using Minimum Data Set reports. A total of 4,920 nursing home residents (4,691 White and 229 Black) with very severe and irreversible cognitive impairment comprised the study population. Factors associated with tube use were examined using bivariate and logistic regression tests. RESULTS: Feeding tube use was strongly associated with swallowing difficulties, Black race, urban location of nursing home, stroke, and absence of dementia in multivariate analysis. Feeding tubes were used in 10.1% of White subjects and in 38.9% of Black subjects for an overall rate of 11.5%. Feeding tube use was greater (P<.001) among Black subjects in all demographic and clinical sub-populations examined. CONCLUSIONS: Feeding tube use is significantly more common in Blacks than in Whites. These findings are consistent with published studies of Black-White differences in preferences for medical treatment at the end of life. Future research efforts should examine end-of-life decision making processes directly. Qualitative methods may be useful in generating new hypotheses regarding the role of ethnicity in these decisions.

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