Racial and ethnic differences in hospice use among patients with heart failure
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Department of Quantitative Health Sciences
Document Type
Journal ArticlePublication Date
2010-03-10Keywords
African AmericansAge 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
Metadata
Show full item recordAbstract
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.Source
Arch Intern Med. 2010 Mar 8;170(5):427-32. Link to article on publisher's siteDOI
10.1001/archinternmed.2009.547Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47619PubMed ID
20212178Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1001/archinternmed.2009.547