Chinese American patients in ICU less likely to get kidney replacement therapy
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Key takeaways:
- Of 266 patients in the ICU, 38 patients received kidney replacement therapy.
- Unadjusted odds of kidney replacement therapy use in Chinese American vs. white American patients was 0.50.
Critically ill Chinese American patients in an ICU were less likely to receive kidney replacement therapy at the end of life compared with patients researchers described as white Americans, published data show.
“Asian Americans represent the fastest growing racial group in the United States,” Seba Babroudi, MD, of Tufts Medical Center in Boston, wrote with colleagues in a research letter. “There is significant heterogeneity of cultural beliefs and end-of-life care intensity preferences among ethnic subgroups within this population.”
According to the study, “Chinese Americans were defined as individuals whose documented race was Asian with language proficiency in Chinese, Mandarin, Cantonese, or Taishanese, whereas white Americans were defined as individuals whose race was documented as non-Hispanic white.”
Patients in these groups who were treated in an ICU between 2014 and 2020, and were previously identified from electronic health records, were matched 1:1 based on sex, age and the year and reason of admission. Babroudi and colleagues conducted a study at an urban tertiary medical center located in the northeastern United States to investigate the incidence of kidney replacement therapy use at the end of life among these populations.
The study included 266 patients. Mean age of Chinese American patients in the study was 79 years and was 77 years for white American patients.
Overall, 10.5% of Chinese American patients and 97.7% of white American patients spoke English as a first language. Prevalent comorbidities, use of invasive mechanical ventilation and rates of advanced care planning at ICU admission were similar between groups.
Of the 266 patients in ICU, 38 received kidney replacement therapy. This was a cumulative incidence of 14.3%, according to the findings. The unadjusted odds of kidney replacement therapy use in Chinese American patients vs. white American patients was 0.50. This finding did not change significantly after adjusting for baseline illness severity and kidney function on admission.
In addition, the researchers found that Chinese American patients had kidney replacement therapy at an absolute incidence rate of 4.19 events per 1,000 patient-days lower than white American patients and had 58% lower odds of receiving the procedure in adjusted analyses.
“Our findings suggest practice differences between these [two] populations, which may be driven by individual (clinician bias and patient preference), institutional and societal factors (culture and language discordance) or a combination,” Babroudi and colleagues wrote. The study shows the “need for multicenter evaluation, with additional identification of clinician- and patient-specific factors to delineate cultural preferences from health disparities and promote equitable, culturally sensitive care in an increasingly diverse America,” they wrote.
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