Racial and ethnic differences in hospice use among patients with heart failure
Department of Quantitative Health Sciences; Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Medical Subject Headings
African Americans; Age Factors; Aged; Aged, 80 and over; Comorbidity; Emergency Service, Hospital; European Continental Ancestry Group; Female; *Heart Failure; Hispanic Americans; Hospice Care; Hospices; Humans; Income; Male; Medicare; Multivariate Analysis; Odds Ratio; Risk Factors; Severity of Illness Index; United States; Urban Population
Biostatistics | Epidemiology | Health Services Research
BACKGROUND: Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure.
METHODS: On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of race and ethnicity on hospice entry for patients with heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors.
RESULTS: In unadjusted analysis, blacks (odds ratio [OR], 0.52) and Hispanics (0.43) used hospice care for heart failure less than whites. Racial and ethnic differences in patients who received hospice care for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted OR for blacks, 0.59; 95% confidence interval, 0.47-0.73; and adjusted OR for Hispanics, 0.49; 95% confidence interval, 0.37-0.66; compared with whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice use.
CONCLUSIONS: In a national sample of Medicare beneficiaries with heart failure, blacks and Hispanics used hospice care for heart failure less than whites after adjustment for individual and market factors. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior is needed.
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Citation: Arch Intern Med. 2010 Mar 8;170(5):427-32. Link to article on publisher's site