Ethnic differences in the place of death of elderly hospice enrollees
Ethnic differences in the place of death of elderly hospice enrollees
复制标题
DOI：
10.1111/j.1532-5415.2005.00502.x
复制
发表时间：
2005-12-01
影响因子：
6.3
通讯作者：
Tulsky, JA
中科院分区：
文献类型：
--
作者：
Johnson, KS;Kuchibhatala, M;Tulsky, JA
与白种人相比，老年少数族裔更有可能在住院环境中死亡。目前尚不清楚这种差异是否是由于对死亡地点的文化偏好或接受临终关怀的机会减少所致。 This analysis examines ethnic differences in the place of death of elderly hospice patients.Using data from a large, national hospice provider, elderly (>= 65) African-American, Hispanic, and Caucasian decedents admitted to hospice between January 1, 2000, and December 31, 2003, were identified.在 115,854 名符合资格的死者中，78.3% 是白人，10.7% 是非裔美国人，11% 是西班牙裔。西班牙裔和非裔美国人在住院临终关怀机构中死亡的可能性高于白种人（分别为 38.5%、38.5% 和 32%）。调整人口和临终关怀使用变量后，老年非裔美国人在住院临终关怀机构的死亡几率高于老年白人，而在疗养院的死亡几率更高（比值比 (OR)=1.12，95% 置信区间 (CI)=1.07-1.19）。然而，与在家中相比，非裔美国人种族并不是住院患者死亡的显着预测因素（OR=1.03，95% CI=0.97-1.08）。西班牙裔美国人在住院临终关怀机构的死亡几率低于白人（OR=0.88，95% CI=0.84, 0.93），在住院临终关怀机构的死亡几率比在疗养院更高（OR=1.45，95% CI=1.37-1.53）。入住临终关怀医院减少但并不能消除死亡地点的种族差异。进一步的研究应该考察个人和文化对死亡地点的偏好对参加临终关怀决定的影响。
Elderly minorities are more likely to die in inpatient settings than their Caucasian counterparts. It is not known whether this difference is due to cultural preferences for place of death or decreased access to hospice. This analysis examines ethnic differences in the place of death of elderly hospice patients.Using data from a large, national hospice provider, elderly (>= 65) African-American, Hispanic, and Caucasian decedents admitted to hospice between January 1, 2000, and December 31, 2003, were identified. Of the 115,854 eligible decedents, 78.3% were Caucasian, 10.7% African American, and 11% Hispanic. Hispanics and African Americans were more likely to die in inpatient hospice settings than Caucasians (38.5%, 38.5%, and 32%, respectively). After adjustment for demographic and hospice use variables, older African Americans had higher odds than older Caucasians of dying in an inpatient hospice setting than a nursing home (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.07-1.19). However, African-American ethnicity was not a significant predictor of death in an inpatient setting versus home (OR=1.03, 95% CI=0.97-1.08)). Hispanics had lower odds than Caucasians of death in an inpatient hospice setting than at home (OR=0.88, 95% CI=0.84, 0.93) and higher odds of death in an inpatient setting than a nursing home (OR=1.45, 95% CI=1.37-1.53).Admission to hospice reduces but does not eliminate ethnic differences in place of death. Further research should examine the effect of individual and cultural preferences for place of death on decisions to enroll in hospice.