Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer
Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer
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DOI：
10.1016/j.jgo.2016.10.001
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发表时间：
2017-03-01
影响因子：
3
通讯作者：
Berger, Nathan A.
中科院分区：
文献类型：
--
作者：
Koroukian, Siran M.;Schiltz, Nicholas K.;Berger, Nathan A.
目的：大多数关于老年癌症患者积极的临终关怀的先前研究都考虑了健康的社会决定因素（例如，种族，收入和教育），但很少为多民族（MM）。在这项研究中，我们研究了临终关怀和每个健康和MM的社会决定因素之间的关联，假设较高的MM与积极性较低的care.Methods：从1991-2008年的健康和退休研究，医疗保险数据，和国家死亡指数，我们确定了收费服务的患者年龄>= 66岁死于癌症（n = 835）。MM定义为慢性疾病、功能受限和/或老年综合征的发生或同时发生。积极治疗是基于在生命的最后两周内接受针对癌症的治疗的索赔衍生措施;在过去一个月内入院和/或急诊科（艾德）;和院内死亡。我们还确定了参加临终关怀的患者。在多变量logistic回归模型中，我们分析了利益的关联，调整潜在的confounders.Results：虽然61.2%的患者参加临终关怀，24.6%进行了癌症定向治疗，55.1%被送往医院和/或艾德，21.7%在医院死亡。我们观察到收入和住院死亡之间的U形分布。慢性疾病和老年综合征与某些结果，但不与others.Conclusions：为了提高质量的临终关怀和减少死亡患者所产生的费用，相关的干预措施需要考虑到健康和MM的社会决定因素在一个微妙的方式。(C)2016爱思唯尔有限公司版权所有
Objective: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care.Methods: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age >= 66 years who died from cancer (n = 835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders.Results: While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others.Conclusions: To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion. (C) 2016 Elsevier Ltd. All rights reserved.