New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ.
Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ.
JCO Oncol Pract. 2020 Jun;16(6):e538-e548. doi: 10.1200/JOP.19.00767. Epub 2020 Apr 16.
Racial and ethnic disparities in cancer care near the end of life (EOL) have been recognized, but EOL care experienced by Medicaid beneficiaries is not well understood. We assessed the prevalence of aggressive EOL care and hospice enrollment for Medicaid beneficiaries and determined whether racial and ethnic disparities exist.
We identified Medicaid beneficiaries (age 21-64 years) who were diagnosed from 2011 to 2015 with stage IV breast and colorectal cancer and who died by January 2016 through a New Jersey State Cancer Registry-Medicaid claims linked data set. We measured aggressive EOL care (> 1 hospitalization, > 1 emergency department [ED] visit, any intensive care unit [ICU] admission in the last 30 days of life, and receipt of chemotherapy in the last 14 days of life) and hospice enrollment. Multivariable logistic regression models were used to determine factors associated with aggressive EOL care and hospice enrollment.
Of the 349 patients, 217 (62%) received at least one of the following measures of aggressive EOL care: > 1 hospitalization (27%), > 1 ED visit (31%), ICU admission (30%), and chemotherapy (34%). The adjusted odds of receiving any aggressive care were 1.87 times higher (95% CI, 1.08 to 3.26) for non-Hispanic (NH) Black patients compared with NH White patients. Only 39% of patients enrolled in hospice. No significant differences in hospice enrollment were observed by race or ethnicity.
The majority of Medicaid patients with advanced cancer received aggressive EOL care and were not enrolled in hospice. NH Black patients were more likely to receive aggressive EOL care. Further work to understand processes leading to suboptimal EOL care within Medicaid populations and among racial and ethnic minority groups is warranted.
人们已经认识到，在癌症临终关怀（EOL）方面存在种族和民族差异，但对医疗补助受益人的 EOL 护理了解甚少。我们评估了医疗补助受益人的侵袭性 EOL 护理和临终关怀入院率，并确定是否存在种族和民族差异。
我们通过新泽西州癌症登记处-医疗补助索赔链接数据集，确定了 2011 年至 2015 年间被诊断患有四期乳腺癌和结直肠癌且在 2016 年 1 月前死亡的年龄在 21-64 岁之间的医疗补助受益患者。我们衡量了侵袭性 EOL 护理（>1 次住院、>1 次急诊就诊、生命最后 30 天内任何 ICU 入院和生命最后 14 天内接受化疗）和临终关怀入院情况。多变量逻辑回归模型用于确定与侵袭性 EOL 护理和临终关怀入院相关的因素。
在 349 名患者中，有 217 名（62%）接受了至少一种以下侵袭性 EOL 护理措施：>1 次住院（27%）、>1 次急诊就诊（31%）、ICU 入院（30%）和化疗（34%）。与非西班牙裔（NH）白种人相比，非 NH 黑种人接受任何侵袭性护理的可能性高 1.87 倍（95%CI，1.08 至 3.26）。只有 39%的患者入组临终关怀。在种族或民族方面，临终关怀的入组率没有显著差异。
大多数患有晚期癌症的医疗补助患者接受了侵袭性 EOL 护理，并未入组临终关怀。NH 黑种人更有可能接受侵袭性 EOL 护理。需要进一步努力了解导致医疗补助人群和少数族裔群体中 EOL 护理不佳的过程。
