Department of Family Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
Palliat Med. 2012 Jan;26(1):61-71. doi: 10.1177/0269216311407693. Epub 2011 May 23.
This study examined whether there are racial disparities for length of stay in hospice for patients with non-small cell lung cancer (NSCLC).We studied 53,626 deceased patients aged ≥66 years diagnosed with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Results-Medicare linked data who used hospice services in the last six months before death, and died between 1 January 1991 and 31 December 2005. Median time (days) and percent length of stay in hospice, and multivariate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) using zero-truncated negative binomial regression described relationships. In 2000-2005, most patients (64.1%) had <30 days, including those (30.2%) with <7 days length of stay in hospice care. After adjusting for confounders, the IRR for length of stay in hospice compared to whites was 38% increased for blacks (IRR = 1.38; 95% CI: 1.01-1.89), and almost three-fold increased for Hispanics (IRR = 2.91;95% CI: 1.15-7.37) at stages I-II. However, blacks at stages III-IV had slightly decreased use of hospice services (IRR = 0.91; 95% CI: 0.85-0.97). Length of stay decreased slightly among blacks diagnosed with late stage (III-IV) NSCLC in 2000-2005.The gap in disparity for length of stay in hospice has narrowed for ethnic minorities compared to whites, while some ethnic minorities had greater length of stay at early disease stage.
本研究旨在探讨非小细胞肺癌（NSCLC）患者在临终关怀机构的住院时间是否存在种族差异。我们研究了从监测、流行病学和最终结果-医疗保险链接数据中确定的年龄≥66 岁、患有 AJCC 分期 I-IV 期 NSCLC 的 53626 名已故患者，这些患者在死亡前的最后 6 个月内使用了临终关怀服务，并于 1991 年 1 月 1 日至 2005 年 12 月 31 日期间死亡。使用零截断负二项回归描述中位时间（天）和临终关怀住院时间的百分比，以及多变量发病率比（IRR）及其 95%置信区间（CI）。2000-2005 年，大多数患者（64.1%）的住院时间<30 天，其中包括<7 天临终关怀护理时间的患者（30.2%）。调整混杂因素后，与白人相比，黑人的住院时间 IRR 增加了 38%（IRR=1.38；95%CI：1.01-1.89），西班牙裔的 IRR 增加了近三倍（IRR=2.91；95%CI：1.15-7.37）在 I-II 期。然而，III-IV 期的黑人使用临终关怀服务的比例略有下降（IRR=0.91；95%CI：0.85-0.97）。2000-2005 年，诊断为晚期（III-IV 期）NSCLC 的黑人住院时间略有缩短。与白人相比，少数民族在临终关怀住院时间方面的差异差距有所缩小，而一些少数民族在疾病早期的住院时间更长。
