Introduction: Do-not-resuscitate (DNR) orders are common after stroke and have recently received increased attention. However, there has been little study of trends in DNR status. We investigated time trends in DNR use after stroke in a community with a large minority population.
Methods: Cases of ischemic stroke (IS) or intracerebral hemorrhage (ICH) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) study from June 2007 through October 2016. Demographics, clinical characteristics, and DNR status were collected from medical charts by trained abstractors. Race-ethnic differences in DNR orders were assessed with logistic regression models and adjusted for potential confounders. Time trends were assessed with a linear term for time (years) and further explored with interaction terms between time and race-ethnicity or time and stroke type.
Results: After excluding cases with missing DNR status and recurrent events, 2,860 cases were available. Mean age was 69 (range 45-102), 50% were female, and race-ethnicity was Mexican American (MA, 58%), non-Hispanic White (NHW, 37%), and African American (AA, 5%). Overall, 17% had a DNR order during the hospitalization. Time trends in DNR orders differed for IS and ICH (interaction p=0.04, see Table). However, change in DNR status over time within each stroke type was modest (non-significant increase over time for IS and non-significant decrease for ICH). MAs were less likely than NHWs to have DNR orders (p=0.007) There was no evidence of interaction between time and race-ethnicity (p=0.57), suggesting that the race-ethnic disparity is stable over time.
Conclusions: Use of DNR orders after stroke has been largely stable over the past 10 years, with only slight differences in time trends comparing IS to ICH. Mexican Americans remain less likely than NHWs to use DNR orders after stroke with no evidence of change over time.