Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer.
Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer.
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DOI：
10.1111/j.1532-5415.2008.02081.x
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发表时间：
2009-01
影响因子：
6.3
通讯作者：
McCarthy EP
中科院分区：
文献类型：
--
作者：
Smith AK;Earle CC;McCarthy EP
研究绝症患者在使用临终关怀和高强度护理方面的种族和民族差异。回溯性、二次数据分析。监测、流行病学和最终结果--1992至1999年间的医疗保险数据库，以及截至2001年12月31日的随访数据。40,960名65岁及以上患有晚期肺癌、结直肠癌、乳腺癌和前列腺癌的非西班牙裔白人、非西班牙裔黑人、亚裔和西班牙裔按服务收费的医疗保险受益人。临终关怀使用和生命末期高强度护理指标。42.0%的老年晚期癌症白人患者登记在临终关怀中心，而黑人(36.9%)、亚裔(32.2%)和西班牙裔(37.7%)患者的登记人数较低。白人和西班牙裔患者之间的差异在调整了临床和社会人口学因素后消失了。黑人和亚裔患者住院2次以上(分别为11.7%、15.0%、13.7%)、住院14天以上(分别为11.4%、17.4%、15.6%)、在生命最后一个月住进重症监护病房(分别为12.0%、17.0%、16.2%)、死亡(分别为26.5%、31.3%、33.7%)的比例高于白人患者。在调整后，按种族或族裔接受高强度护理的未经调整的差异仍然存在。与白人相比，黑人和亚洲晚期癌症患者更有可能经常住院，时间更长，更有可能住进ICU，在医院死亡，并以较低的比率进入临终关怀。需要进一步的研究来检验患者的偏好或其他因素在多大程度上解释了这些差异。
To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illness. Retrospective, secondary data analysis. Surveillance, Epidemiology, and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31, 2001. Forty thousand nine hundred sixty non-Hispanic white, non-Hispanic black, Asian, and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung, colorectal, breast, and prostate cancer. Hospice use and indicators of high-intensity care at the end of life. Whereas 42.0% of elderly white patients with advanced cancer enrolled in hospice, enrollment was lower for black (36.9%), Asian (32.2%), and Hispanic (37.7%) patients. Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors. Higher proportions of black and Asian patients than of white patients were hospitalized two or more times (11.7%, 15.0%, 13.7%, respectively), spent more than 14 days hospitalized (11.4%, 17.4%, 15.6%, respectively), and were admitted to the intensive care unit (ICU) (12.0%, 17.0%, 16.2%, respectively) in the last month of life and died in the hospital (26.5%, 31.3%, 33.7%, respectively). Unadjusted differences in receipt of high-intensity care according to race or ethnicity remained after adjustment. Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods, be admitted to the ICU, die in the hospital, and be enrolled in hospice at lower rates. Further research is needed to examine the degree to which patient preferences or other factors explain these differences.
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影响因子：
5.7
作者：
Smith, Alexander K.;Davis, Roger B.;Krakauer, Eric L.
通讯作者：
Krakauer, Eric L.
DOI：
10.1111/j.1532-5415.2007.01510.x
发表时间：
2008-01-01
影响因子：
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作者：
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120.7
作者：
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120.7
作者：
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通讯作者：
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