Hospice usage by minorities in the last year of life: Results from the national mortality followback survey
Hospice usage by minorities in the last year of life: Results from the national mortality followback survey
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DOI：
10.1046/j.1365-2389.2003.51310.x
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发表时间：
2003-07-01
影响因子：
6.3
通讯作者：
Ahluwalia, JS
中科院分区：
文献类型：
--
作者：
Greiner, KA;Perera, S;Ahluwalia, JS
目的：研究一个国家队列中临终关怀使用率的种族/民族差异，并确定与临终关怀使用相关的个体特征。设计：对1993年全国死亡率跟踪调查（NMFS）的二次分析，这是一个使用死亡证明和亲属访谈获得的全国样本（代理受访者）提供死亡率、社会和经济数据以及23岁以下儿童生命最后一年的医疗保健利用信息，地点：临终关怀。参与者：1993年死亡的15岁及以上的个人。如果受试者死于非创伤性原因（N = 11，291），则纳入本分析。MEASUREMENTS：临终关怀的使用由代理反应进行二分，表明使用或不使用家庭或住院临终关怀服务。在生命的最后一年使用临终关怀服务的个人的百分比计算。结果：未经调整的双变量结果发现，非洲裔美国人不太可能比白人使用临终关怀（比值比（OR）= 0.59; P < .001），而那些没有生活意愿（LW）（OR = 0.23; P <0.001）和没有癌症诊断（OR = 0.28; P <0.001）的患者不太可能使用临终关怀。非裔美国人和临终关怀的使用之间的负面关系是不受影响的性别，教育，婚姻状况，存在的LW，收入和获得医疗保健。Logistic模型显示，LW的存在减少了非裔美国人和临终关怀使用之间的负相关，但后者仍然显着（OR 0.83; P = .033）。对55岁及以上受试者的亚组分析显示，在临终关怀使用方面，获得护理和种族/民族之间存在显著的相互作用（P = .044）。收入在这个多变量的logistic模型衰减非洲裔美国人的种族/民族和临终关怀的使用（OR = 0.77）之间的关系，白人和非洲裔美国人之间的差异变得只有轻微的统计显着（P = 0.060）。结论：在1993年NMFS，临终关怀的使用与非洲裔美国人的种族/民族独立的收入和获得医疗保健呈负相关。这种关系与年龄、保险类型或中风史无关。对于55岁及以上的受试者，获得医疗保健可能是非洲裔美国人种族/民族与临终关怀使用之间负相关的重要混杂因素。与以前的研究一致，这项分析发现，非洲裔美国人比白人更不可能使用LW。非裔美国人的种族/民族对临终关怀使用的重要性降低，包括存在的LW在逻辑模型表明，类似的文化过程可能会塑造非洲裔美国人和白人之间的差异，在提前护理规划和临终关怀使用。
OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a national cohort and to identify individual characteristics associated with hospice use.DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey (NMFS), a nationally obtained sample using death certificates and interviews with relatives (proxy respondents) to provide mortality, social, and economic data and information about healthcare utilization in the last year of life for 23,000 deceased individuals.SETTING: Hospice care.PARTICIPANTS: Individuals aged 15 and older who died in 1993. Subjects were included in this analysis if they died of nontraumatic causes (N = 11,291).MEASUREMENTS: Hospice use was dichotomized by proxy responses indicating use or nonuse of home or inpatient hospice services. The percentage of individuals using hospice services in the last year of life was calculated.RESULTS: Unadjusted bivariate results found that African Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P < .001) and that those without a living will (LW) (OR = 0.23; P < .001) and without a cancer diagnosis (OR = 0.28; P < .001) were less likely to use hospice. The negative relationship between African Americans and hospice use was unaffected when controlled for sex, education, marital status, existence of a LW, income, and access to health care. Logistic models revealed that presence of a LW diminished the negative relationship between African Americans and hospice use, but the latter remained significant (OR 0.83; P = .033). A subanalysis of subjects aged 55 and older showed a significant interaction between access to care and race/ethnicity with respect to hospice use (P = .044). Inclusion of income in this multivariable logistic model attenuated the relationship between African-American race/ethnicity and hospice use (OR = 0.77), and the difference between whites and African Americans became only marginally statistically significant (P = .060).CONCLUSION: In the 1993 NMFS, hospice use was negatively associated with African-American race/ethnicity independent of income and access to healthcare. The relationship is not independent of age, insurance type, or history of stroke. For subjects aged 55 and older, access to healthcare may be an important confounder of the negative relationship between African-American race/ethnicity and hospice use. Consistent with previous studies, this analysis found that African Americans were less likely to use LWs than whites. The reduced importance of African-American race/ethnicity on hospice use with the inclusion of presence of a LW in logistic models suggests that similar cultural processes may shape differences between African Americans and whites in advance care planning and hospice use.