Source
Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120-1613, USA. jhaas@partners.org
Abstract
BACKGROUND:
Although hospice care can alleviate suffering at the end of life for patients with cancer, it remains underutilized, particularly by African Americans and Hispanics.
OBJECTIVE:
To examine whether the racial composition of the census tract where an individual resides is associated with hospice use.
DESIGN:
Retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare file for individuals dying from breast, colorectal, lung, or prostate cancer (n = 70,669).
MEASUREMENTS:
Hospice use during the 12 months before death.
RESULTS:
Hospice was most commonly used by individuals who lived in areas with fewer African-American and Hispanic residents (47%), and was least commonly used by individuals who lived in areas with a high percentage of African-American and Hispanic residents (35%). Hispanics (odds ratio 0.51, 95% confidence interval 0.29-0.91) and African Americans (0.56, 0.44-0.71) were less likely to use hospice if they lived in a census tract with a high percentage of both African Americans and Hispanics than if they lived in a low minority tract. African Americans and whites were less likely to receive hospice care if they lived in a census tract with a high percentage of Hispanics than if they lived in a low minority area.
CONCLUSIONS:
Increasing hospice use may require interventions to improve the delivery of hospice care in minority communities.