Race and residence: intercounty variation in black-white differences in hospice use.
Race and residence: intercounty variation in black-white differences in hospice use.
复制标题
DOI：
10.1016/j.jpainsymman.2012.12.006
复制
发表时间：
2013-11
影响因子：
4.7
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
--
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Payne, Richard;Tulsky, James A.
虽然在美国黑人使用临终关怀的比率低于白人，临终关怀使用的种族差异因地理区域而异。描述县际差异的黑白差异临终关怀的使用和相关的卫生保健资源的供应。受试者是2008年死亡的北卡罗来纳州和南卡罗来纳州的医疗保险受益人的回顾性队列。使用Wilcoxon检验和logistic回归，我们检查了医疗保健资源供应的差异（65岁及以上人口的医院床位和医生，全科医生的百分比等）。在临终关怀使用方面存在种族差异和没有种族差异的县之间。在有种族差异的县，白人使用临终关怀的比例显著高于黑人（P<0.05）。在128个县的76，283名死者中，19.78%是黑人。在临终关怀服务使用存在种族差异的39个县（30.47%）中，白人参加临终关怀服务的平均比例为41.3%，黑人为28.66%（P<0.0001）。每65岁及以上人口拥有更多医院床位的县在临终关怀使用方面存在种族差异的几率较高（OR 1.39，95% CI 1.04，1.86），而那些拥有较大比例的全科医生的县的几率较低（OR 0.01，95% CI 0.001，0.476）。在大多数县，黑人和白人的临终关怀使用率相似。在种族不平等的县，有更多的资源提供积极的护理（即，医院病床、专科医生）。由于更倾向于维持生命的治疗，黑人可能更有可能在生命结束时使用急性护理服务，因为提供这些服务的资源很容易获得。
Although Blacks use hospice at lower rates than Whites in the U.S., racial differences in hospice use vary by geographic area. To describe intercounty variability in Black-White differences in hospice use and the association with supply of health care resources. Subjects were a retrospective cohort of Medicare beneficiaries in North and South Carolina who died in 2008. Using Wilcoxon tests and logistic regression, we examined differences in the supply of health care resources (hospital beds and physicians per population age 65 years and older, percentage of generalists, etc.) between counties with and without racial disparity in hospice use. Counties with a racial disparity had significantly (P<0.05) higher rates of hospice use among Whites than Blacks. Of 76,283 decedents in 128 counties, 19.78% were Black. In the 39 counties (30.47%) with racial disparity in hospice use, the mean proportion of Whites who enrolled in hospice was 41.3% vs. 28.66% of Blacks (P<0.0001). Counties with more hospital beds per population age 65 years and older had a higher odds (OR 1.39, 95% CI 1.04, 1.86) and those with a larger proportion of generalists had a lower odds (OR 0.01, 95% CI 0.001, 0.476) of having a racial disparity in hospice use. In most counties, rates of hospice use were similar for Blacks and Whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds, specialists). Because of a greater preference for life-sustaining therapies, Blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available.
登录
查看更多内容
影响因子：
6.3
作者：
Johnson, Kimberly S.;Kuchibhatla, Maragatha;Tulsky, James A.
通讯作者：
Tulsky, James A.
影响因子：
3.4
作者：
Iwashyna, TJ;Chang, VW;Christakis, NA
通讯作者：
Christakis, NA
影响因子：
6.3
作者：
Smith AK;Earle CC;McCarthy EP
通讯作者：
McCarthy EP
影响因子：
--
作者：
Givens, Jane L.;Tjia, Jennifer;Ash, Arlene S.
通讯作者：
Ash, Arlene S.
DOI：
10.1016/0021-9681(86)90103-7
发表时间：
1986-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
GREER, DS;MOR, V;BIRNBAUM, H
通讯作者：
BIRNBAUM, H