Division of Gynecologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Division of Health Equity, Department of Population Science, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California, USA.
Cancer. 2022 Sep 15;128(18):3352-3359. doi: 10.1002/cncr.34385. Epub 2022 Jul 8.
Cancer patients often prefer to die at home, a location associated with better quality of death (QoD). Several studies demonstrate disparities in end-of-life care among immigrant populations in the United States. This study aimed to evaluate how immigrant status affects location and quality of death among patients with advanced cancer in the United States.
Data were derived from Coping with Cancer, a federally funded multi-site prospective study of advanced cancer patients and caregivers. The sample of patients who died during the study period was weighted (N = 308) to reduce statistically significant differences between immigrant (N = 49) and nonimmigrant (N = 259) study participants. Primary outcomes were location of death, death at preferred location, and poor QoD.
Analyses adjusted for covariates indicated that patients who were immigrants were more likely to die in a hospital than home (adjusted odds ratio [AOR], 3.33; 95% confidence interval [CI], 1.65-6.71) and less likely to die where they preferred (AOR, 0.42; 95% CI, 0.20-0.90). Furthermore, immigrants were more likely to have poor QoD (AOR, 5.47; 95% CI, 2.70-11.08).
Immigrants, as compared to nonimmigrants, are more likely to die in hospital settings, less likely to die at their preferred location, and more likely to have poor QoD.
Cancer patients typically prefer to die in their own homes, which is associated with improved quality of death. However, disparities in end-of-life care among immigrant populations in the United States remain significant. Our study found that immigrants are less likely to die in their preferred locations and more likely to die in hospital settings, resulting in poorer quality of death.
癌症患者通常更愿意在家中离世，因为在家中死亡与更好的死亡质量（QoD）相关。多项研究表明，美国移民群体在临终关怀方面存在差异。本研究旨在评估移民身份如何影响美国晚期癌症患者的死亡地点和质量。
数据来自联邦资助的多地点前瞻性研究“应对癌症”，该研究对象为晚期癌症患者及其护理人员。对研究期间死亡的患者样本进行了加权（N=308），以减少移民（N=49）和非移民（N=259）研究参与者之间的统计显著差异。主要结局是死亡地点、首选地点死亡和较差的 QoD。
调整了协变量的分析表明，移民患者更有可能在医院而不是家中死亡（调整后的优势比 [AOR]，3.33；95%置信区间 [CI]，1.65-6.71），更不可能在他们首选的地方死亡（AOR，0.42；95% CI，0.20-0.90）。此外，移民患者更有可能出现较差的 QoD（AOR，5.47；95% CI，2.70-11.08）。
与非移民相比，移民更有可能在医院环境中死亡，更不可能在他们首选的地点死亡，并且更有可能出现较差的 QoD。
癌症患者通常更愿意在自己家中离世，因为这与提高死亡质量相关。然而，美国移民群体在临终关怀方面的差异仍然显著。我们的研究发现，移民更不可能在他们首选的地点死亡，更有可能在医院环境中死亡，导致死亡质量较差。
