Rubens Muni, Ramamoorthy Venkataraghavan, Saxena Anshul, Das Sankalp, Appunni Sandeep, Rana Sagar, Puebla Brittany, Suarez Deborah T, Khawand-Azoulai Mariana, Medina Suleyki, Viamonte-Ros Ana
1 Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
2 University of Central Missouri, Warrensburg, MO, USA.
Am J Hosp Palliat Care. 2019 Apr;36(4):294-301. doi: 10.1177/1049909118809975. Epub 2018 Nov 1.
: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS).
: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations.
: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, P < .01). Factors associated with higher palliative care consultations were increasing age, ≥80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84).
: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use.
尽管美国的姑息治疗服务正在增加，但在可及性和利用率方面仍存在差异。因此，我们使用全国住院患者样本（NIS）对晚期癌症住院患者的这些因素进行了探究。
这是一项对2005年至2014年NIS数据的回顾性分析，纳入了年龄≥18岁、患有或未接受姑息治疗会诊的晚期癌症患者。χ检验和独立t检验分别用于分类变量和连续变量。多因素逻辑回归用于确定与姑息治疗会诊相关的因素。
在4732172例加权晚期癌症住院患者中，有9.9%记录了姑息治疗会诊，且在2005年至2014年期间从3.0%增至15.5%（相对增幅为172.2%，P<.01）。与更高姑息治疗会诊率相关的因素包括年龄增加（≥80岁，比值比[OR]：1.47；95%置信区间[CI]：1.38 - 1.56）、黑人种族（OR：1.21；95% CI：1.14 - 1.28）、私人保险覆盖（OR：1.10；95% CI：1.02 - 1.18）、西部地区（OR：1.15；95% CI：1.01 - 1.33）、大型医院（OR：1.19；95% CI：1.02 - 1.34）、高收入（OR：1.08；95% CI：1.08 - 1.17）、“不要复苏”（临终患者）状态（OR：10.55；95% CI：10.14 - 10.99）以及院内放疗（OR：1.13；95% CI：1.06 - 1.21）。接受化疗的患者姑息治疗会诊率较低（OR：0.71；95% CI：0.60 - 0.84）。
在姑息治疗会诊中发现了许多人口统计学、社会经济、医疗保健和地理方面的差异。此外，晚期癌症住院患者对姑息治疗资源利用不足，而临终患者则普遍使用。医疗保健提供者和政策制定者应关注这些差异，以改善姑息治疗的使用情况。
