Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer.
Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer.
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卵巢癌患者临终护理质量的医疗保健获取维度和种族差异。
DOI：
10.1158/2767-9764.crc-23-0283
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Akinyemiju,TomiF
中科院分区：
文献类型：
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作者：
Karanth,Shama;Osazuwa-Peters,OyomoareL;Wilson,LaurenE;Previs,RebeccaA;Rahman,Fariha;Huang,Bin;Pisu,Maria;Liang,Margaret;Ward,KevinC;Schymura,MariaJ;Berchuck,Andrew;Akinyemiju,TomiF
这项研究调查了非西班牙裔黑人(NHB)、非西班牙裔白人(NHW)和西班牙裔卵巢癌患者在临终关怀(EOL)质量方面的种族差异与卫生保健途径(HCA)维度之间的关联。这项回顾性队列研究使用了2008至2015年间65岁及以上被诊断为卵巢癌的女性的监测、流行病学和与最终结果相关的医疗保险数据。在人口普查区域或区域层面评估了卫生保健的可负担性、可获得性和可获得性指标，并酌情使用多变量调整的回归模型检验了这些指标与EOL护理质量之间的关联。最终的样本包括4646名女性[平均年龄(SD)，77.5(7.0)岁]；87.4%的nhw，6.9%的nhb和5.7%的西班牙裔。在多变量调整的模型中，负担能力与重症监护病房住院风险[调整后相对风险(ARR)0.90，95%可信区间(CI)：0.83-0.98]和住院死亡风险(ARR：0.91，95%CI：0.84-0.98)相关。在对HCA维度进行调整后，NHB患者的EOL护理质量低于NHW患者，定义为：在生命的最后30天内住院风险增加(ARR 1.16，95%CI：1.03-1.30)，没有临终关怀(ARR 1.23，95%CI：1.04-1.44)，住院死亡(ARR 1.27，95%CI：1.03-1.57)，以及较高的不良EOL护理结果计数(计数比：1.19，95%CI：1.04-1.36)。HCA维度是EOL护理质量的有力预测因素；然而，种族差异仍然存在，表明这些差异的其他驱动因素仍有待确定。在卵巢癌患者中，黑人患者的EOL护理质量较低，即使在调整了HCA的三个结构性障碍后也是如此，即可负担性、可用性和可及性。这表明有必要调查尚未探索的HCA障碍的作用，如适应和可接受性，作为卵巢癌黑人患者低质量EOL护理的驱动因素。
This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03–1.30), no hospice care (aRR 1.23, 95% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified.SignificanceAmong patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.