Hospice Use Among Urban Black and White US Nursing Home Decedents in 2006
Hospice Use Among Urban Black and White US Nursing Home Decedents in 2006
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DOI：
10.1093/geront/gnq093
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发表时间：
2011-04-01
期刊：
影响因子：
5.7
通讯作者：
Gozalo, Pedro
中科院分区：
文献类型：
--
作者：
Lepore, Michael J.;Miller, Susan C.;Gozalo, Pedro
目的：医疗安宁疗护是生命末期优质疗护的宝贵来源，但少数族裔群体对其使用率较低令人关注。本研究确定了美国城市黑人和白人养老院（NH）死者使用临终关怀的相关因素。设计与方法：结合多元资料来源，运用多元逻辑回归检视2006年曾接受安宁疗护的城市黑人与白人NH居民（N = 288,202）对安宁疗护的使用情况。结果：在NHs中，黑人比白人更不可能使用临终关怀（35.4%比39.3%），即使控制了协变量、相互作用和NHs和县的死者聚类（调整后的优势比= 0.81,95%置信区间= 0.77-0.86）。在安宁疗护使用方面，黑人亚群间的差异大于黑人与白人之间的差异，且这些差异主要是由个人层面的因素造成的，nhh水平的因素也有一定影响。黑人对临终关怀的使用率高于白人，而黑人对充血性心力衰竭（CHF）的使用率低于白人。此外，与没有不复苏或不住院订单或癌症的黑人相比，与其他NHs相比，低层次的黑人使用临终关怀服务的比例更高。黑人患者的临终关怀使用率也低于非慢性心力衰竭患者。结论：减少安宁疗护使用的种族差异，应注意个人层面的因素。加强预先指示的使用，针对患有心力衰竭的黑人进行临终关怀可能特别有帮助。
Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States. Design and Methods: Multiple data sources are combined and multilevel logistic regression is utilized to examine hospice use among urban Black and White NH residents who had access to hospice and died in 2006 (N = 288,202). Results: In NHs, Blacks are less likely to use hospice than Whites (35.4% vs. 39.3%), even when controlling for covariates, interactions, and clustering of decedents in NHs and counties (adjusted odds ratio = 0.81, 95% confidence interval = 0.77-0.86). Variation in hospice use is greater among subgroups of Blacks than between Blacks and Whites, and these variations are predominantly due to individual-level factors, with some influence of NH-level factors. Hospice use is higher for Blacks versus Whites with do-not-resuscitate orders and lower for Blacks versus Whites with congestive heart failure (CHF). Additionally, hospice use is greater among Blacks with versus without do-not-resuscitate or do-not-hospitalize orders or cancer and those in low-tier versus other NHs. There was also lower hospice use among Blacks with versus without CHF. Implications: Efforts to reduce racial differences in hospice use should attend to individual-level factors. Heightening use of advance directives and targeting Blacks with CHF for hospice could be particularly helpful.