Katherine Ornstein|David L. Roth|Jin Huang|Emily B Levitan|J. Rhodes|Chanee Fabius|Monika M. Safford|Orla C. Sheehan
Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort
Icahn School of Medicine at Mount Sinai|Johns Hopkins University|Johns Hopkins University|University of Alabama at Birmingham|University of Alabama at Birmingham|Johns Hopkins University|Cornell University|Johns Hopkins University
h3importanceh3 although hospice use increasing patients us increasingly dying home racial disparities treatment intensity end life including hospice use remain h3objectiveh3 examine differences black white patients endoflife care population sample wellcharacterized causes death h3design setting participantsh3 study used data reasons geographic racial differences stroke regards study ongoing populationbased cohort study enrollment january 25 2003 october 3 2007 linkage medicare claims data multivariable logistic regression models used examine racial regional differences endoflife outcomes stroke mortality among 1212 participants feeforservice medicare died january 1 2013 december 31 2015 owing natural causes excluding sudden death oversampling black individuals residents southeastern states united states initial analyses conducted march 2019 final primary analyses conducted february 2020 h3main outcomes measuresh3 primary outcomes interest hospice use 3 days last 6 months life derived medicare claims files outcomes included multiple hospitalizations emergency department visits use intensive procedures last 6 months life cause death adjudicated expert panel clinicians using death certificates proxy interviews autopsy reports medical records h3resultsh3 sample consisted 1212 participants 630 men 520 378 black individuals 312 mean sd age death 810 86 years 2542 total deaths black decedents less likely white decedents use hospice 3 days 132 378 349 vs 385 834 462ipi lt 001 stratification cause death substantial racial differences treatment intensity service use found among persons died cardiovascular disease among patients died cancer analyses adjusted cause death dementia cancer cardiovascular disease clinical demographic variables black decedents significantly less likely use 3 days hospice odds ratio 072 95 ci 054096 likely multiple emergency department visits 135 95 ci 101180 hospitalizations 139 95 ci 102189 undergo intensive treatment 194 95 ci 140270 last 6 months life compared white decedents h3conclusions relevanceh3 despite increase use hospice care recent decades racial disparities use hospice remain especially noncancer deaths research required better understand racial disparities access quality endoflife care