Department of Chronic Disease Epidemiology, 5755Yale University School of Public Health, New Haven, CT, USA.
Department of Health Services Policy and Management, Arnold School of Public Health, 5755University of South Carolina, SC, USA.
Am J Hosp Palliat Care. 2021 Jun;38(6):626-633. doi: 10.1177/1049909120988506. Epub 2021 Jan 21.
Despite well-documented disparities in end-of-life (EOL) care, little is known about whether patients with low health literacy (LHL) received aggressive EOL care.
This study examined the association between health literacy (HL) and EOL care intensity among Medicare beneficiaries.
We conducted a retrospective analysis of Medicare fee-for-service decedents who died in July-December, 2011. ZIP-code-level HL scores were estimated from the 2010-2011 Health Literacy Data Map, where a score of 225 or lower was defined as LHL. Aggressive EOL care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last 6 months of life, in-hospital death, and any of above. Using hierarchical generalized linear models, we examined the association between HL and aggressive EOL care.
Of 649,556 decedents, the proportion of decedents who received any aggressive EOL care among those in LHL areas was 82.7%, compared to 72.7% in HHL areas. In multivariable analyses, decedents residing in LHL areas, compared to those in HHL areas, had 31% higher odds of aggressive EOL care (adjusted odds ratio [AOR] 1.31; 95% confidence interval [CI]:1.21-1.42), including higher odds of no hospice use (AOR 1.35; 95% CI: 1.27-1.44), repeated hospitalization (AOR 1.07; 95% CI: 1.01-1.14) and in-hospital death (AOR 1.21; 95% CI: 1.13-1.29).
Medicare beneficiaries who resided in LHL areas were likely to receive aggressive EOL care. Tailored efforts to improve HL and facilitate patient-provider communications in LHL areas could reduce EOL care intensity.
尽管在生命末期（EOL）护理方面存在有据可查的差异，但对于低健康素养（LHL）患者是否接受积极的 EOL 护理知之甚少。
本研究调查了医疗保险受益人的健康素养（HL）与 EOL 护理强度之间的关系。
我们对 2011 年 7 月至 12 月期间去世的医疗保险按服务收费的死者进行了回顾性分析。ZIP 代码级 HL 评分是根据 2010-2011 年健康素养数据图估算得出的，其中评分 225 或更低被定义为 LHL。积极的 EOL 护理措施包括在生命的最后 30 天内多次住院、在生命的最后 6 个月内未登记临终关怀、院内死亡和上述任何一种情况。使用分层广义线性模型，我们研究了 HL 与积极的 EOL 护理之间的关系。
在 649556 名死者中，在 LHL 地区接受任何积极 EOL 护理的死者比例为 82.7%，而在 HHL 地区为 72.7%。在多变量分析中，与 HHL 地区的死者相比，居住在 LHL 地区的死者接受积极的 EOL 护理的可能性高 31%（调整后的优势比[OR]1.31；95%置信区间[CI]：1.21-1.42），包括使用临终关怀的可能性降低（OR 1.35；95% CI：1.27-1.44）、重复住院（OR 1.07；95% CI：1.01-1.14）和院内死亡（OR 1.21；95% CI：1.13-1.29）。
居住在 LHL 地区的医疗保险受益人更有可能接受积极的 EOL 护理。在 LHL 地区，有针对性地提高 HL 并促进医患沟通，可以降低 EOL 护理强度。
