Ethnic disparities in hospice use among asian-american and pacific islander patients dying with cancer
Ethnic disparities in hospice use among asian-american and pacific islander patients dying with cancer
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DOI：
10.1111/j.1532-5415.2007.01510.x
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发表时间：
2008-01-01
影响因子：
6.3
通讯作者：
McCarthy, Ellen P.
中科院分区：
文献类型：
--
作者：
Ngo-Metzger, Quyen;Phillips, Russell S.;McCarthy, Ellen P.
亚裔美国人和太平洋岛民 (AAPI) 在美国人口增长迅速，但人们对临终关怀中心的使用以及因癌症死亡的老年 AAPI 人在临终关怀中心的停留时间知之甚少。对在监测、流行病学和最终结果计划中注册的 AAPI 和白人医疗保险受益人的最后一年进行了回顾性研究。研究对象为 65 岁及以上、死于肺癌、结直肠癌、乳腺癌、前列腺癌、胃癌或肝癌的白人 (n=175,467) 和 AAPI (n=8,614) 患者。 Cox 比例风险模型用于检查临终关怀中心的使用和临终关怀中心的停留时间。研究的所有 AAPI 亚组的临终关怀使用率均较低（中国人（调整后风险比 (HR)=0.62，95% 置信区间 (CI)=0.55-0.69）、日本人（调整后 HR=0.67，95% CI=0.60-0.73）、菲律宾人（调整后 HR=0.61，95% CI=0.54-0.70）、夏威夷/太平洋岛民（调整后的 HR=0.78，95% CI=0.67-0.91）和其他亚洲人（调整后的 HR=0.70），95% CI=0.55-0.90）高于白人患者，并根据患者人口统计和临床特征进行调整。在参加临终关怀的患者中（约占总样本的 20%），日裔美国人的中位住院时间较短（21 天），菲律宾裔美国人的中位住院时间（32 天）比白人患者（26 天）更长。总体而言，大约 20% 的患者在死亡后 7 天内入组，只有 6% 的患者住院时间超过 2 个月，不同种族或民族之间没有显着差异。总之，在研究的每个种族亚群体中，亚太裔参加临终关怀机构的可能性低于白人。需要进一步的研究来了解这些差异并消除临终关怀的潜在障碍。
Asian Americans and Pacific Islanders (AAPIs) are a rapidly growing population in the United States, yet little is known about hospice use and length of stay in hospice of older AAPIs dying with cancer. A retrospective study was conducted of the last year of life of AAPI and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results Program. White (n=175,467) and AAPI (n=8,614) patients aged 65 and older who were dying with lung, colorectal, breast, prostate, gastric, or liver cancer were studied. Cox proportional hazards models were used to examine hospice use and length of stay in hospice. All AAPI subgroups studied had lower rates of hospice use (Chinese (adjusted hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.55-0.69), Japanese (adjusted HR=0.67, 95% CI=0.60-0.73), Filipino (adjusted HR=0.61, 95% CI=0.54-0.70), Hawaiian/Pacific Islanders (adjusted HR=0.78, 95% CI=0.67-0.91), and other Asians (adjusted HR=0.70), 95% CI=0.55-0.90) than white patients, adjusting for patient demographic and clinical characteristics. Of those who enrolled in hospice (approximately 20% of the total sample), Japanese Americans had a shorter median length of stay (21 days), and Filipino Americans had a longer median length of stay (32 days) than white patients (26 days). Overall, approximately 20% of patients enrolled within 7 days of death, and only 6% had hospice stays that were longer than 2 months, with no significant differences across racial or ethnic groups. In conclusion, in every ethnic subgroup studied, AAPIs were less likely than whites to enroll in hospice. Further research is needed to understand these differences and eliminate potential barriers to hospice care.