Racial Differences in Time to Withdrawal of Care after Intracerebral Hemorrhage

Persistent Link:
http://hdl.handle.net/10150/317039
Title:
Racial Differences in Time to Withdrawal of Care after Intracerebral Hemorrhage
Author:
Shaw, Kristen Marie
Issue Date:
2014
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Intro/Aims: Differences in end-of-life decision-making among minorities have been well described. However, among Native Hawaiian and Other Pacific Islanders (NHOPIs), this has not been well studied. Aim 1: Determine if differences in time to withdrawal of life support (WOLS) exist between NHOPIs and non-Hispanic whites (NHWs). Aim 2: If differences in time to WOLS between races are found, examine factors that may contribute to these differences. Methods: A retrospective study was conducted on patients admitted to a primary stroke center in Honolulu with diagnosis of spontaneous intracerebral hemorrhage (ICH). Medical records were reviewed for occurrence of WOLS and time of WOLS. Unadjusted and multivariable logistic regression models were performed to determine associations between race and WOLS. Kaplan Meier analysis and Cox regression were performed to estimate survival time to WOLS and to compare these results between racial groups. Results: 396 patients with diagnosis of spontaneous ICH were studied. Mean time to WOLS after ICH was found to be similar between NHWs and NHOPIs (p = .925). Prevalence of WOLS was significantly lower in NHOPIs in univariate analysis (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15, 0.80) and Kaplan Meier analysis predicted a significant difference in WOLS between NHOPI and NHWs within 30 days of ICH (p =<. 01). However, in multivariate analysis, race was no longer significant when adjusted for age (OR 0.59, 95% CI 0.25, 1.43) and when fully adjusted (OR 0.68, 95% CI 0.20, 2.39). NHOPIs were significantly younger at the time of ICH when compared to NHWs (p =<.001) although ICH severity and presentation such as initial Glasgow Coma Scale, presence of intraventricular hemorrhage and ICH volume were similar (p = .241; p = .604; p = .901, respectively). Conclusions: No difference in mean time to WOLS was noted between NHOPIs and NHW. However, secondary analysis showed WOLS was less prevalent after ICH in the NHOPI population compared to NHWs, although the significance of this finding was attenuated by age. NHOPIs in this population likely had a lower incidence of WOLS due to the fact that they presented with ICH at a significantly younger age, although small sample size also may have resulted in difficulty detecting variances between races.
Type:
text; Electronic Dissertation
Keywords:
ICH; Life support; Racial; Stroke; Nursing; Hawaiian
Degree Name:
D.N.P.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
Gallek, Matthew J.
Committee Chair:
Gallek, Matthew J.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.titleRacial Differences in Time to Withdrawal of Care after Intracerebral Hemorrhageen_US
dc.creatorShaw, Kristen Marieen_US
dc.contributor.authorShaw, Kristen Marieen_US
dc.date.issued2014-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractIntro/Aims: Differences in end-of-life decision-making among minorities have been well described. However, among Native Hawaiian and Other Pacific Islanders (NHOPIs), this has not been well studied. Aim 1: Determine if differences in time to withdrawal of life support (WOLS) exist between NHOPIs and non-Hispanic whites (NHWs). Aim 2: If differences in time to WOLS between races are found, examine factors that may contribute to these differences. Methods: A retrospective study was conducted on patients admitted to a primary stroke center in Honolulu with diagnosis of spontaneous intracerebral hemorrhage (ICH). Medical records were reviewed for occurrence of WOLS and time of WOLS. Unadjusted and multivariable logistic regression models were performed to determine associations between race and WOLS. Kaplan Meier analysis and Cox regression were performed to estimate survival time to WOLS and to compare these results between racial groups. Results: 396 patients with diagnosis of spontaneous ICH were studied. Mean time to WOLS after ICH was found to be similar between NHWs and NHOPIs (p = .925). Prevalence of WOLS was significantly lower in NHOPIs in univariate analysis (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15, 0.80) and Kaplan Meier analysis predicted a significant difference in WOLS between NHOPI and NHWs within 30 days of ICH (p =<. 01). However, in multivariate analysis, race was no longer significant when adjusted for age (OR 0.59, 95% CI 0.25, 1.43) and when fully adjusted (OR 0.68, 95% CI 0.20, 2.39). NHOPIs were significantly younger at the time of ICH when compared to NHWs (p =<.001) although ICH severity and presentation such as initial Glasgow Coma Scale, presence of intraventricular hemorrhage and ICH volume were similar (p = .241; p = .604; p = .901, respectively). Conclusions: No difference in mean time to WOLS was noted between NHOPIs and NHW. However, secondary analysis showed WOLS was less prevalent after ICH in the NHOPI population compared to NHWs, although the significance of this finding was attenuated by age. NHOPIs in this population likely had a lower incidence of WOLS due to the fact that they presented with ICH at a significantly younger age, although small sample size also may have resulted in difficulty detecting variances between races.en_US
dc.typetexten
dc.typeElectronic Dissertationen
dc.subjectICHen_US
dc.subjectLife supporten_US
dc.subjectRacialen_US
dc.subjectStrokeen_US
dc.subjectNursingen_US
dc.subjectHawaiianen_US
thesis.degree.nameD.N.P.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorGallek, Matthew J.en_US
dc.contributor.chairGallek, Matthew J.en_US
dc.contributor.committeememberGallek, Matthew J.en_US
dc.contributor.committeememberNakagawa, Kazumaen_US
dc.contributor.committeememberSheppard, Kate G.en_US
dc.contributor.committeememberRitter, Leslieen_US
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