Table 3.

Adjusted association of black versus white race with patterns of end-of-life care by quintile of end-of-life expenditure index

Patterns of End-of-Life CareQuintile of End-of-Life Expenditure Index
All Patients1st (Lowest)2nd3rd4th5th (Highest)P for Interaction
All patients, n101,33114,53518,09819,70121,91927,078
 Died in hospital OR (95% CI)1.43 (1.38 to 1.48)1.15 (1.00 to 1.32)1.48 (1.33 to 1.58)1.40 (1.30 to 1.51)1.43 (1.32 to 1.54)1.24 (1.16 to 1.33)<0.001a
 Dialysis discontinuation OR (95% CI)b0.47 (0.45 to 0.49)0.63 (0.54 to 0.74)0.57 (0.51 to 0.63)0.51 (0.46 to 0.56)0.50 (0.46 to 0.55)0.47 (0.43 to 0.51)<0.001a
 Hospice referral OR (95% CI)0.53 (0.51 to 0.56)0.81 (0.69 to 0.96)0.59 (0.53 to 0.65)0.49 (0.45 to 0.54)0.56 (0.52 to 0.62)0.55 (0.50 to 0.60)<0.001a
Patients who died within 6 mo, n36,781502962956998805810,401
 Died in hospital OR (95% CI)1.42 (1.33 to 1.51)1.39 (1.08 to 1.80)1.47 (1.26 to 1.71)1.38 (1.20 to 1.57)1.37 (1.21 to 1.56)1.21 (1.08 to 1.35)0.18
 Dialysis discontinuation OR (95% CI)b0.45 (0.42 to 0.49)0.63 (0.47 to 0.84)0.51 (0.43 to 0.61)0.47 (0.40 to 0.55)0.46 (0.40 to 0.54)0.48 (0.42 to 0.56)0.40
 Hospice referral OR (95% CI)0.50 (0.46 to 0.54)0.82 (0.61 to 1.10)0.47 (0.39 to 0.57)0.46 (0.39 to 0.55)0.51 (0.44 to 0.60)0.55 (0.47 to 0.64)0.03a
  • All analyses adjusted for age, sex, body mass index, estimated GFR, coronary artery disease, peripheral arterial disease, diabetes mellitus, congestive heart failure, stroke, cancer, chronic obstructive pulmonary disease, ability to walk, ability to transfer, treatment modality, prior nephrology care, preemptive transplantation, hemodialysis access, and cause of death. The referent group for this analysis is white patients. P for interaction indicates whether the association of race and the outcome of interest differ by end-of-life expenditure index. OR, odds ratio; CI, confidence interval.

  • a Indicates P for interaction <0.05.

  • b Denominator excludes patients who received a kidney transplant.