Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure
Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure
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DOI：
10.1001/archinternmed.2009.547
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发表时间：
2010-03-08
影响因子：
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通讯作者：
Ash, Arlene S.
中科院分区：
文献类型：
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作者：
Givens, Jane L.;Tjia, Jennifer;Ash, Arlene S.
背景：心力衰竭是临终关怀患者的主要非癌症诊断，也是医疗保险受益人住院的主要原因。癌症患者的临终关怀患者的种族和民族差异已得到充分记录，但对于心力衰竭患者的描述却很少。 方法：根据 2001 年 1 月 1 日全国 98 258 名 66 岁及以上医疗保险受益人的样本，这些受益人被诊断为心力衰竭，至少有 1 次医生或医院就诊，并且在 2000 年 1 月 1 日至 12 月 31 日期间没有参加临终关怀，我们确定了在调整了社会人口统计学、临床和地理因素后，2001 年心力衰竭患者进入临终关怀中心时的种族和民族情况。结果：在未经调整的分析中，黑人（比值比 [OR]，0.52）和西班牙裔人（0.43）使用临终关怀治疗心力衰竭的人数少于白人。在调整了收入、城市生活、疾病严重程度、当地临终关怀使用密度和医疗合并症等指标后，接受心力衰竭临终关怀的患者的种族和民族差异仍然存在（黑人调整后 OR，0.59；95% 置信区间，0.47-0.73；西班牙裔调整后 OR，0.49；95% 置信区间，0.37-0.66；与白人相比）。高龄、合并症较多、急诊科就诊、住院治疗以及临终关怀服务的当地密度较大也与临终关怀服务的使用有关。结论：在患有心力衰竭的医疗保险受益人的全国样本中，在调整个人和市场因素后，黑人和西班牙裔因心力衰竭而使用临终关怀护理的次数少于白人。为了了解这些发现背后的机制，需要进一步检查患者的偏好和医生的转诊行为。
Background: Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure.Methods: On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of race and ethnicity on hospice entry for patients with heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors.Results: In unadjusted analysis, blacks ( odds ratio [OR], 0.52) and Hispanics (0.43) used hospice care for heart failure less than whites. Racial and ethnic differences in patients who received hospice care for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity ( adjusted OR for blacks, 0.59; 95% confidence interval, 0.47-0.73; and adjusted OR for Hispanics, 0.49; 95% confidence interval, 0.37-0.66; compared with whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice use.Conclusions: In a national sample of Medicare beneficiaries with heart failure, blacks and Hispanics used hospice care for heart failure less than whites after adjustment for individual and market factors. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior is needed.