Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State

Panattoni, Laura; McDermott, Cara L.; Li, Li; Sun, Qin; Fedorenko, Catherine R.; Sanchez, Hayley; Kreizenbeck, Karma L.; Shankaran, Veena; Ramsey, Scott D.

doi:10.1200/jco.22.00070

Cited by 3 publications

(4 citation statements)

References 33 publications

(45 reference statements)

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“…For example, Medicaid patients from Washington were more likely to die in a hospital or without hospice services. 5 Our study finds that pandemic-related disruptions to place of death trends are ongoing, national, and extend to non–COVID-19–related diagnoses. Our study is limited by the imperfect classification of the place of death variables within the CDC WONDER database, including ambiguity regarding how assisted living facilities should be classified.…”

Section: Discussionmentioning

confidence: 59%

“…Prior studies showed how COVID-19 exacerbated access issues at the end of life immediately after the onset of the pandemic. For example, Medicaid patients from Washington were more likely to die in a hospital or without hospice services . Our study finds that pandemic-related disruptions to place of death trends are ongoing, national, and extend to non–COVID-19–related diagnoses.…”

Section: Discussionmentioning

confidence: 64%

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Place of Death Before and During the COVID-19 Pandemic

Teasdale,

Narayan,

Harman

et al. 2024

JAMA Netw Open

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 64%

Place of Death Before and During the COVID-19 Pandemic

Teasdale,

Narayan,

Harman

et al. 2024

JAMA Netw Open

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“…Indeed, for patients with the lowest SES, home deaths increased only among those without SPC support during the month before death. A similar inequity was demonstrated in a US study: for Medicaid-insured (but not commercially insured) patients with advanced cancer, place of death shifted from hospital to home without hospice during the first 4 months of the COVID-19 pandemic . The relative increase in home deaths unsupported by SPC or hospice among socioeconomically disadvantaged populations during the COVID-19 pandemic could be due to patients wanting to avoid inpatient care but lacking access to or knowledge of end-of-life resources that would normally facilitate and support a home death.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19

Iqbal,

Moineddin,

Fowler

et al. 2024

JAMA Netw Open

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ImportanceThe COVID-19 pandemic had a profound impact on the delivery of cancer care, but less is known about its association with place of death and delivery of specialized palliative care (SPC) and potential disparities in these outcomes.ObjectiveTo evaluate the association of the COVID-19 pandemic with death at home and SPC delivery at the end of life and to examine whether disparities in socioeconomic status exist for these outcomes.Design, Setting, and ParticipantsIn this cohort study, an interrupted time series analysis was conducted using Ontario Cancer Registry data comprising adult patients aged 18 years or older who died with cancer between the pre–COVID-19 (March 16, 2015, to March 15, 2020) and COVID-19 (March 16, 2020, to March 15, 2021) periods. The data analysis was performed between March and November 2023.ExposureCOVID-19–related hospital restrictions starting March 16, 2020.Main Outcomes and MeasuresOutcomes were death at home and SPC delivery at the end of life (last 30 days before death). Socioeconomic status was measured using Ontario Marginalization Index area-based material deprivation quintiles, with quintile 1 (Q1) indicating the least deprivation; Q3, intermediate deprivation; and Q5, the most deprivation. Segmented linear regression was used to estimate monthly trends in outcomes before, at the start of, and in the first year of the COVID-19 pandemic.ResultsOf 173 915 patients in the study cohort (mean [SD] age, 72.1 [12.5] years; males, 54.1% [95% CI, 53.8%-54.3%]), 83.7% (95% CI, 83.6%-83.9%) died in the pre–COVID-19 period and 16.3% (95% CI, 16.1%-16.4%) died in the COVID-19 period, 54.5% (95% CI, 54.2%-54.7%) died at home during the entire study period, and 57.8% (95% CI, 57.5%-58.0%) received SPC at the end of life. In March 2020, home deaths increased by 8.3% (95% CI, 7.4%-9.1%); however, this increase was less marked in Q5 (6.1%; 95% CI, 4.4%-7.8%) than in Q1 (11.4%; 95% CI, 9.6%-13.2%) and Q3 (10.0%; 95% CI, 9.0%-11.1%). There was a simultaneous decrease of 5.3% (95% CI, −6.3% to –4.4%) in the rate of SPC at the end of life, with no significant difference among quintiles. Patients who received SPC at the end of life (vs no SPC) were more likely to die at home before and during the pandemic. However, there was a larger immediate increase in home deaths among those who received no SPC at the end of life vs those who received SPC (Q1, 17.5% [95% CI, 15.2%-19.8%] vs 7.6% [95% CI, 5.4%-9.7%]; Q3, 12.7% [95% CI, 10.8%-14.5%] vs 9.0% [95% CI, 7.2%-10.7%]). For Q5, the increase in home deaths was significant only for patients who did not receive SPC (13.9% [95% CI, 11.9%-15.8%] vs 1.2% [95% CI, −1.0% to 3.5%]).Conclusions and RelevanceThese findings suggest that the COVID-19 pandemic was associated with amplified socioeconomic disparities in death at home and SPC delivery at the end of life. Future research should focus on the mechanisms of these disparities and on developing interventions to ensure equitable and consistent SPC access.

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“…3 During the Covid-19 pandemic, important changes in the place of death were observed in different countries. [4][5][6][7][8] In the UK, there was a sustained increase in home deaths. 5 Very little is understood about the characteristics of people who died at home during the pandemic, and how they differed compared to pre-pandemic time periods.…”

Section: Introductionmentioning

confidence: 99%

Deaths at home, area-based deprivation and the effect of the Covid-19 pandemic: An analysis of mortality data across four nations

et al. 2023

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Background: The number and proportion of home deaths in the UK increased during the Covid-19 pandemic. It is not known whether these changes were experienced disproportionately by people from different socioeconomic groups. Aim: To examine the association between home death and socioeconomic position during the Covid-19 pandemic, and how this changed between 2019 and 2020. Design: Retrospective cohort study using population-based individual-level mortality data. Setting/participants: All registered deaths in England, Wales, Scotland and Northern Ireland. The proportion of home deaths between 28th March and 31st December 2020 was compared with the same period in 2019. We used Poisson regression models to evaluate the association between decedent’s area-based level of deprivation and risk of home death, as well as the interaction between deprivation and year of death, for each nation separately. Results: Between the 28th March and 31st December 2020, 409,718 deaths were recorded in England, 46,372 in Scotland, 26,410 in Wales and 13,404 in Northern Ireland. All four nations showed an increase in the adjusted proportion of home deaths between 2019 and 2020, ranging from 21 to 28%. This increase was lowest for people living in the most deprived areas in all nations, with evidence of a deprivation gradient in England. Conclusions: The Covid-19 pandemic exacerbated a previously described socioeconomic inequality in place of death in the UK. Further research to understand the reasons for this change and if this inequality has been sustained is needed.

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Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State

Cited by 3 publications

References 33 publications

Place of Death Before and During the COVID-19 Pandemic

Place of Death Before and During the COVID-19 Pandemic

Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19

Deaths at home, area-based deprivation and the effect of the Covid-19 pandemic: An analysis of mortality data across four nations

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