Racial and Ethnic Differences in End-of-Life Medicare Expenditures.
Racial and Ethnic Differences in End-of-Life Medicare Expenditures.
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DOI：
10.1111/jgs.14263
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发表时间：
2016-09
影响因子：
6.3
通讯作者：
Iwashyna TJ
中科院分区：
文献类型：
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作者：
Byhoff E;Harris JA;Langa KM;Iwashyna TJ
确定在生命的最后六个月内，医疗保险支出的种族和民族差异在多大程度上可以通过人口统计学、社会支持、社会经济、地理、医疗和EOL规划因素来解释。回顾性队列研究健康与退休研究（HRS）7，105名死者在1998-2012年期间参加了健康与退休研究，并且之前同意调查与医疗保险索赔的联系。按种族和民族划分的生命最后180天内的医疗保险总支出，控制人口统计学因素、社会支持、地理、疾病负担和EOL计划因素，包括是否存在预先指示、讨论EOL治疗偏好以及是否预期死亡。我们的分析包括5548名（78.1%）非西班牙裔白色、1030名（14.5%）非西班牙裔黑人、331名（4.7%）西班牙裔和196名（2.8%）其他人种/种族的成年人。未经调整的结果表明，在EOL时，黑人死者的平均医疗保险支出比白人多13，522美元（35%，p <0.001），而西班牙裔的医疗保险支出则多16，341美元（42%，p<0.001）。控制人口统计学，社会经济，地理，医疗和EOL特定因素，与非西班牙裔白人的支出相比，黑人和西班牙裔死者的医疗保险支出差异分别减少到8，047美元（22%，p <0.001）和6，855美元（19%，p<0.001）。在所有模型中，组间支出差异在统计学上仍然显著。在生命的最后六个月，医疗保险支出的种族和民族差异不能完全由患者层面的因素解释，包括EOL规划因素。未来的研究应侧重于更广泛的系统，组织和供应商层面的因素来解释这些差异。
To determine to what extent racial and ethnic variation in Medicare spending during the last six months of life are explained by demographic, social support, socioeconomic, geographic, medical and EOL planning factors. Retrospective cohort study Health and Retirement Study (HRS) 7,105 decedents who participated in the Health and Retirement Study between 1998–2012 and previously consented to survey linkage with Medicare claims. Total Medicare expenditures in the last 180 days of life by race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected. Our analysis included 5548 (78.1%) non-Hispanic white, 1030 (14.5%) non-Hispanic black, 331 (4.7%) Hispanic, and 196 (2.8%) adults of other race/ethnicity. Unadjusted results suggest that average Medicare expenditures for black decedents was $13,522 (35%, p <0.001) more than for whites, while Medicare expenditures for Hispanics was $16,341 (42%, p<0.001) more at EOL. Controlling for demographic, socioeconomic, geographic, medical and EOL specific factors, the Medicare expenditure difference between groups reduced to $8,047 (22%, p<0.001) more for black and $6,855 (19%, p<0.001) more for Hispanic decedents compared to non-Hispanic whites’ expenditures. The expenditure differences between groups remained statistically significant across all models. Racial and ethnic differences in Medicare spending in the last six months of life are not fully explained by patient-level factors, including EOL planning factors. Future research should focus on broader systemic, organizational and provider level factors to explain these differences.