Dataset Information

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort.

ABSTRACT: Importance:Although hospice use is increasing and patients in the US are increasingly dying at home, racial disparities in treatment intensity at the end of life, including hospice use, remain. Objective:To examine differences between Black and White patients in end-of-life care in a population sample with well-characterized causes of death. Design, Setting, and Participants:This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing population-based cohort study with enrollment between January 25, 2003, and October 3, 2007, with linkage to Medicare claims data. Multivariable logistic regression models were used to examine racial and regional differences in end-of-life outcomes and in stroke mortality among 1212 participants with fee-for-service Medicare who died between January 1, 2013, and December 31, 2015, owing to natural causes and excluding sudden death, with oversampling of Black individuals and residents of Southeastern states in the United States. Initial analyses were conducted in March 2019, and final primary analyses were conducted in February 2020. Main Outcomes and Measures:The primary outcomes of interest were hospice use of 3 or more days in the last 6 months of life derived from Medicare claims files. Other outcomes included multiple hospitalizations, emergency department visits, and use of intensive procedures in the last 6 months of life. Cause of death was adjudicated by an expert panel of clinicians using death certificates, proxy interviews, autopsy reports, and medical records. Results:The sample consisted of 1212 participants (630 men [52.0%]; 378 Black individuals [31.2%]; mean [SD] age at death, 81.0 [8.6] years) of 2542 total deaths. Black decedents were less likely than White decedents to use hospice for 3 or more days (132 of 378 [34.9%] vs 385 of 834 [46.2%]; P?

SUBMITTER: Ornstein KA

PROVIDER: S-EPMC7445597 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort.

Ornstein Katherine A KA Roth David L DL Huang Jin J Levitan Emily B EB Rhodes J David JD Fabius Chanee D CD Safford Monika M MM Sheehan Orla C OC

JAMA network open 20200803 8

<h4>Importance</h4>Although hospice use is increasing and patients in the US are increasingly dying at home, racial disparities in treatment intensity at the end of life, including hospice use, remain.<h4>Objective</h4>To examine differences between Black and White patients in end-of-life care in a population sample with well-characterized causes of death.<h4>Design, setting, and participants</h4>This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) stud ...[more]

PMID: 32833020

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Project description:BackgroundPrior work has identified disparities in the quality and outcomes of healthcare across socioeconomic subgroups. Medication use may be subject to similar disparities.ObjectiveTo assess the association between demographic and socioeconomic factors (gender, age, race, income, education, and rural or urban residence) and appropriateness of medication use.MethodsUS adults aged ≥45 years (n = 26,798) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included in the analyses, of which 13,623 participants aged ≥65 years (recruited 2003-2007). Potentially inappropriate medication (PIM) use in older adults and drug-drug interactions (DDIs) were identified through 2015 Beers Criteria and clinically significant drug interactions list by Ament et al., respectively as measures of medication appropriateness. Multivariable logistic regression was used to assess the association of disparity parameters with PIM use and DDIs. Interactions between race and other disparity variables were investigated.ResultsApproximately 87% of the participants aged ≥65 years used at least one drug listed in the Beers Criteria, and 3.8% of all participants used two or more drugs with DDIs. Significant gender-race interaction across prescription-only drug users revealed that white females compared with white males (OR = 1.33, 95% CI 1.20-1.48) and black males compared with white males (OR = 1.60, 95% CI 1.41-1.82) were more likely to receive PIM. Individuals with lower income and education also were more likely to use PIM in this sub-group. Females were less likely than males (female vs. male: OR = 0.55, 95% CI 0.48-0.63) and individuals resided in small rural areas as opposed to urban areas (small rural vs. urban: OR = 1.37, 95% CI 1.07-1.76) were more likely to have DDIs.ConclusionDemographic and socioeconomic disparities in PIM use and DDIs exist. Future studies should seek to better understand factors contributing to the disparities in order to guide development of interventions.

Project description:ObjectiveHealth disparities are pervasive in nursing homes (NHs), but disparities in NH end-of-life (EOL) care (ie, hospital transfers, place of death, hospice use, palliative care, advance care planning) have not been comprehensively synthesized. We aim to identify differences in NH EOL care for racial/ethnic minority residents.DesignA systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42020181792).Setting and participantsOlder NH residents who were terminally ill or approaching the EOL, including racial/ethnic minority NH residents.MethodsThree electronic databases were searched from 2010 to May 2020. Quality was assessed using the Newcastle-Ottawa Scale.ResultsEighteen articles were included, most (n = 16) were good quality and most (n = 15) used data through 2010. Studies varied in definitions and grouping of racial/ethnic minority residents. Four outcomes were identified: advance care planning (n = 10), hospice (n = 8), EOL hospitalizations (n = 6), and pain management (n = 1). Differences in EOL care were most apparent among NHs with higher proportions of Black residents. Racial/ethnic minority residents were less likely to complete advance directives. Although hospice use was mixed, Black residents were consistently less likely to use hospice before death. Hispanic and Black residents were more likely to experience an EOL hospitalization compared with non-Hispanic White residents. Racial/ethnic minority residents experienced worse pain and symptom management at the EOL; however, no articles studied specifics of palliative care (eg, spiritual care).Conclusions and implicationsThis review identified NH health disparities in advance care planning, EOL hospitalizations, and pain management for racial/ethnic minority residents. Research is needed that uses recent data, reflective of current NH demographic trends. To help reduce EOL disparities, language services and cultural competency training for staff should be available in NHs with higher proportions of racial/ethnic minorities.

Dataset Information

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort.

Publications

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort.

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