Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer

Dale Hardy, Wenyaw Chan, Chih Chin Liu, Janice N. Cormier, Rui Xia, Eduardo Bruera, Xianglin L. Du

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The authors investigated whether there were racial disparities in the receipt of hospice services within geographic residence and socioeconomic status (SES) levels. METHODS: In total, 117,894 patients aged ≥66 years with nonsmall cell lung cancer (NSCLC) were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database who had received hospice services in the last 6 months before death and who died between January 1, 1991 and December 31, 2005. Multivariate odds ratios (ORs) with 95% confidence intervals (CIs) using mixed-effects logistic regression models were used to describe relations. RESULTS: In urban areas, there were significant disparity trends in age/sex-adjusted rates for blacks and Asians/Pacific Islanders compared with whites (P =.003 and P =.036, respectively). Blacks (OR, 0.79; 95% CI, 0.75-0.82), Asians/Pacific Islanders (OR, 0.42; 95% CI, 0.39-0.46), and Hispanics (OR, 0.81; 95% CI, 0.73-0.91) were less likely to receive hospice services. In rural areas, blacks were 21% less likely to receive hospice services (OR, 0.79; 95% CI, 0.63-0.98). Patients in the poorest socioeconomic status (SES) quartile were 7% less likely to receive hospice services (OR, 0.93; 95% CI, 0.86-1.00). Moreover, within stratified SES quartiles, blacks and Asians/Pacific Islanders had lower receipt of hospice services, and Asians/Pacific Islanders were the least likely to receive hospice services, particularly those in the poorest SES quartile. In general, older patients and women were more likely to receive hospice services. CONCLUSIONS: There were substantial disparities in the receipt of hospice services among ethnic minorities within urban and rural areas and within SES levels. The results indicated that efforts are needed to identify barriers, enhance support, and educate patients on the benefits of hospice services. Cancer 2010.

Original languageEnglish (US)
Pages (from-to)1506-1515
Number of pages10
JournalCancer
Volume117
Issue number7
DOIs
StatePublished - Apr 1 2011

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Hospices
Social Class
Non-Small Cell Lung Carcinoma
Odds Ratio
Confidence Intervals
Logistic Models
Medicare
Hispanic Americans
Epidemiology
Databases

Keywords

  • geographic residence
  • hospice services
  • nonsmall cell lung cancer
  • race/ethnicity
  • socioeconomic status

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer. / Hardy, Dale; Chan, Wenyaw; Liu, Chih Chin; Cormier, Janice N.; Xia, Rui; Bruera, Eduardo; Du, Xianglin L.

In: Cancer, Vol. 117, No. 7, 01.04.2011, p. 1506-1515.

Research output: Contribution to journalArticle

Hardy, Dale ; Chan, Wenyaw ; Liu, Chih Chin ; Cormier, Janice N. ; Xia, Rui ; Bruera, Eduardo ; Du, Xianglin L. / Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer. In: Cancer. 2011 ; Vol. 117, No. 7. pp. 1506-1515.
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abstract = "BACKGROUND: The authors investigated whether there were racial disparities in the receipt of hospice services within geographic residence and socioeconomic status (SES) levels. METHODS: In total, 117,894 patients aged ≥66 years with nonsmall cell lung cancer (NSCLC) were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database who had received hospice services in the last 6 months before death and who died between January 1, 1991 and December 31, 2005. Multivariate odds ratios (ORs) with 95{\%} confidence intervals (CIs) using mixed-effects logistic regression models were used to describe relations. RESULTS: In urban areas, there were significant disparity trends in age/sex-adjusted rates for blacks and Asians/Pacific Islanders compared with whites (P =.003 and P =.036, respectively). Blacks (OR, 0.79; 95{\%} CI, 0.75-0.82), Asians/Pacific Islanders (OR, 0.42; 95{\%} CI, 0.39-0.46), and Hispanics (OR, 0.81; 95{\%} CI, 0.73-0.91) were less likely to receive hospice services. In rural areas, blacks were 21{\%} less likely to receive hospice services (OR, 0.79; 95{\%} CI, 0.63-0.98). Patients in the poorest socioeconomic status (SES) quartile were 7{\%} less likely to receive hospice services (OR, 0.93; 95{\%} CI, 0.86-1.00). Moreover, within stratified SES quartiles, blacks and Asians/Pacific Islanders had lower receipt of hospice services, and Asians/Pacific Islanders were the least likely to receive hospice services, particularly those in the poorest SES quartile. In general, older patients and women were more likely to receive hospice services. CONCLUSIONS: There were substantial disparities in the receipt of hospice services among ethnic minorities within urban and rural areas and within SES levels. The results indicated that efforts are needed to identify barriers, enhance support, and educate patients on the benefits of hospice services. Cancer 2010.",
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T1 - Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer

AU - Hardy, Dale

AU - Chan, Wenyaw

AU - Liu, Chih Chin

AU - Cormier, Janice N.

AU - Xia, Rui

AU - Bruera, Eduardo

AU - Du, Xianglin L.

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N2 - BACKGROUND: The authors investigated whether there were racial disparities in the receipt of hospice services within geographic residence and socioeconomic status (SES) levels. METHODS: In total, 117,894 patients aged ≥66 years with nonsmall cell lung cancer (NSCLC) were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database who had received hospice services in the last 6 months before death and who died between January 1, 1991 and December 31, 2005. Multivariate odds ratios (ORs) with 95% confidence intervals (CIs) using mixed-effects logistic regression models were used to describe relations. RESULTS: In urban areas, there were significant disparity trends in age/sex-adjusted rates for blacks and Asians/Pacific Islanders compared with whites (P =.003 and P =.036, respectively). Blacks (OR, 0.79; 95% CI, 0.75-0.82), Asians/Pacific Islanders (OR, 0.42; 95% CI, 0.39-0.46), and Hispanics (OR, 0.81; 95% CI, 0.73-0.91) were less likely to receive hospice services. In rural areas, blacks were 21% less likely to receive hospice services (OR, 0.79; 95% CI, 0.63-0.98). Patients in the poorest socioeconomic status (SES) quartile were 7% less likely to receive hospice services (OR, 0.93; 95% CI, 0.86-1.00). Moreover, within stratified SES quartiles, blacks and Asians/Pacific Islanders had lower receipt of hospice services, and Asians/Pacific Islanders were the least likely to receive hospice services, particularly those in the poorest SES quartile. In general, older patients and women were more likely to receive hospice services. CONCLUSIONS: There were substantial disparities in the receipt of hospice services among ethnic minorities within urban and rural areas and within SES levels. The results indicated that efforts are needed to identify barriers, enhance support, and educate patients on the benefits of hospice services. Cancer 2010.

AB - BACKGROUND: The authors investigated whether there were racial disparities in the receipt of hospice services within geographic residence and socioeconomic status (SES) levels. METHODS: In total, 117,894 patients aged ≥66 years with nonsmall cell lung cancer (NSCLC) were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database who had received hospice services in the last 6 months before death and who died between January 1, 1991 and December 31, 2005. Multivariate odds ratios (ORs) with 95% confidence intervals (CIs) using mixed-effects logistic regression models were used to describe relations. RESULTS: In urban areas, there were significant disparity trends in age/sex-adjusted rates for blacks and Asians/Pacific Islanders compared with whites (P =.003 and P =.036, respectively). Blacks (OR, 0.79; 95% CI, 0.75-0.82), Asians/Pacific Islanders (OR, 0.42; 95% CI, 0.39-0.46), and Hispanics (OR, 0.81; 95% CI, 0.73-0.91) were less likely to receive hospice services. In rural areas, blacks were 21% less likely to receive hospice services (OR, 0.79; 95% CI, 0.63-0.98). Patients in the poorest socioeconomic status (SES) quartile were 7% less likely to receive hospice services (OR, 0.93; 95% CI, 0.86-1.00). Moreover, within stratified SES quartiles, blacks and Asians/Pacific Islanders had lower receipt of hospice services, and Asians/Pacific Islanders were the least likely to receive hospice services, particularly those in the poorest SES quartile. In general, older patients and women were more likely to receive hospice services. CONCLUSIONS: There were substantial disparities in the receipt of hospice services among ethnic minorities within urban and rural areas and within SES levels. The results indicated that efforts are needed to identify barriers, enhance support, and educate patients on the benefits of hospice services. Cancer 2010.

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