|Title||Multimorbidity and racial disparities in use of hospice by older patients dying from cancer.|
|Publication Type||Journal Article|
|Year of Publication||2014|
|Authors||Koroukian, SM, Schiltz, NK, Warner, D, Given, CW, Owusu, C, Schluchter, M, Berger, NA|
|Journal||Journal of Clinical Oncology|
|Keywords||Cancer, Death, multimorbidity, National Death Index, race, race difference, race-ethnicity|
9542 Background: While previous studies have documented lower use of hospice by Non-Hispanic Blacks (NHBs) than by Non-Hispanic Whites (NHWs), racial variations have not been examined in the context of multimorbidity (MM), which affects minority patients disproportionately. We sought to determine the impact of MM severity on NHBs’ use of hospice in a U.S. representative sample of older adults. Methods: We used data from the linked 1991-2008 Health and Retirement Study (HRS), Medicare data, and the National Death Index (NDI). From the NDI, we identified fee-for-service patients ≥65 years of age who died from cancer (n=812), and retrieved their demographic data, presence of comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS) from their last HRS interview. We characterized severity of MM by 3 levels: none or only one of COM, FL, or GS (MM0/1); presence of two of COM, FL, or GS (MM2); or presence of all three of COM, FL, and GS (MM3). Hospice use was identified from Medicare claims data. We developed multivariable logistic regression models to analyze the association between race and hospice use, adjusting for MM and other patient covariates. Results: Nearly 12% of the study population was NHB; 61.3% of NHBs and 53.0% of NHWs were identified in MM3 (p=0.057). Overall, 61% of the patients received hospice care (63.7% in NHWs, and 43.0% in NHBs, p < 0.001). The distribution NHBs and NHWs by MM was similar across hospice users and non-users. Adjusting for MM and other confounders, NHBs were significantly less likely than NHWs to utilize hospice (Adjusted odds ratio: 0.42, 95% Confidence Interval: 0.27-0.66, p < 0.001). Conclusions: Despite the greater representation of NHBs in the highest severity of MM category, NHBs remain significantly less likely than NHWs to use hospice, even after adjusting for MM. The findings carry important implications with regard to disparities in providing optimal, and cost effective quality of end-of-life care.