Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure

Abstract

Background Heart failure is the leading non-cancer hospice diagnosis and the leading cause of hospitalization among Medicare beneficiaries. Racial differences in hospice use are well documented for cancer but poorly described for heart failure. Methods Based on a national sample of 98,258 Medicare beneficiaries aged 66 and older on January 1, 2001 with a diagnosis of heart failure, who were not enrolled in hospice in 2000, we determined the effect of race/ethnicity on hospice entry for heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors. Results In unadjusted analysis, Blacks (odds ratio [OR] = 0.52) and Hispanics (OR = 0.43) used hospice for heart failure less than Whites. Racial/ethic differences in hospice use for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted odds ratio (AOR) for Blacks [AOR = 0.59 (95% confidence interval (CI), 0.47-0.73)], and for Hispanics [AOR = 0.49 (95% CI 0.37-0.66)], compared to Whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice utilization. Conclusions In a national sample of Medicare beneficiaries with heart failure, Blacks and Hispanics used hospice for heart failure less than Whites after adjustment for individual and market factors. This work extends the findings of racial and ethnic differences in hospice utilization to the leading non-cancer diagnosis. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior are needed.

Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

“…Moreover, some studies have found that African Americans have higher rates of heart-failurerelated hospitalizations compared with Caucasians (Deswal, Petersen, Urbauer, Wright, & Beyth, 2006;Husaini et al, 2011). Historically African Americans have experienced inequality in the quality of health care they have received, and consequently may distrust the medical system, preferring active treatment over palliative care (Allen, Allen, Hilgeman, & DeCoster, 2008;Braun, Beyth, Ford, & McCullough, 2008;Givens Tjia, Zhou, Emanuel, & Ash, 2010;LaVeist, Nickerson & Bowie, 2000). These factors can have important implications for how African Americans approach medical care, their access to services, and their desire for medical information and treatment (Torke, Corbie-Smith, & Branch, 2004).…”

Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients

“…Local hospice utilization, previously defined by Givens et al as the proportion of deaths in each HSA that occurred while the patient was enrolled in hospice, reflects regional patterns of hospice utilization. 31 We used data from the years 2005 to 2009 to calculate the local hospice utilization for each HSA, and then grouped the spectrum of values into tertiles representing high, medium, and low hospice utilization areas. We defined 30-day hospice enrollment as the presence of at least one Medicare hospice claim within 30 days after the index hospitalization admission date.…”

Racial/Ethnic Minority Access to End-of-Life Care: A Conceptual Framework

“…Studies evaluating hospice and palliative care programs have reported improved pain control (Ciemins, Blum, Nunley, Lasher, & Newman, 2007;Elsayem et al, 2004;Hanlon, Perera, Sevick, Rodriguez, & Jaffe, 2010;Miller, Mor, & Teno, 2003), improved patient and family satisfaction with care (Brumley et al, 2007;Dy, Shugarman, Lorenz, Mularski, & Lynn, 2008;Gade et al, 2008;O'Mahoney, Blank, Zallman, & Selwyn, 2005;Teno et al, 2004), and in some cases increased survival rates (Connor, Pyenson, Fitch, Spence, & Iwasaki, 2007). Despite this significant growth, studies have consistently documented the underuse of these services by minorities (for the purpose of this article, minorities refers to both racial and ethnic minorities; Enguídanos, Yip, & Wilber, 2005;Givens, Tjia, Zhou, Emanuel, & Ash, 2010;Greiner, Perera, & Ahluwalia, 2003;Johnson, Kuchibhatla, Tanis, & Tulsky, 2008;Kwak, Haley, & Chiriboga, 2008;Ngo-Metzger, Phillips, & McCarthy, 2008;Smith, Earle, & McCarthy, 2009). While studies have identified several factors contributing to reduced rates of EOL care usage among minorities, research has yet to incorporate the full scope of factors in operation, thus impeding the development of more comprehensive interventions capable of improving minority EOL care access.…”