Guo Ling, Murali Komal P, Morrison R Sean, Hua May
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
NYU Rory Meyers College of Nursing, New York, New York, USA.
J Am Geriatr Soc. 2025 Jun 25. doi: 10.1111/jgs.19587.
Although racial disparities in end-of-life care exist, whether the effect of specialist palliative care (PC) on end-of-life outcomes differs by race is unknown.
We created a propensity-matched cohort of Black and non-Hispanic White (NHW) older adults with metastatic cancer who did and did not receive specialist PC in the last 6 months of life. End-of-life outcomes included hospice use, hospice enrollment ≥ 3 days, intensive care unit (ICU) use in the last 30 days of life, and use of chemotherapy in the last 14 days of life. We used Cox regression models to evaluate for the presence of interaction between specialist PC and race for all outcomes on the multiplicative scale using interaction terms, and on the additive scale using the relative risk due to interaction (RERI), attributable proportion (AP) and synergy index (SI).
After 1:1 matching, 13,931 exposed and 13,931 unexposed older adults were included, of which 13.4% were Black. In comparison to those who did not receive specialist PC, both Black and NHW older adults who received specialist PC were more likely to use hospice (71.0% versus 52.4% for Black, p < 0.0001; 80.4% versus 63.2% for NHW, p < 0.0001), have hospice enrollment ≥ 3 days (65.5% versus 44.0% for Black, p < 0.0001; 74.2% versus 52.6% for NHW, p < 0.0001), and have less use of the ICU (16.4% versus 19.9% for Black, p = 0.0058; 11.3% versus 14.0% for NHW, p < 0.0001) or chemotherapy at the end-of-life (1.2% versus 2.4% for Black, p = 0.0075, 1.4% versus 3.4% for NHW, p < 0.0001). There was no evidence of multiplicative interaction or additive interaction for any outcome.
In older adults with metastatic cancer, there was no evidence for heterogeneity of effect for specialist PC between Black and NHW patients, suggesting that differences in the efficacy of specialist PC are not responsible for racial disparities in end-of-life care.
尽管临终关怀方面存在种族差异，但专科姑息治疗（PC）对临终结局的影响是否因种族而异尚不清楚。
我们创建了一个倾向匹配队列，纳入了患有转移性癌症的黑人和非西班牙裔白人（NHW）老年人，这些老年人在生命的最后6个月接受或未接受专科PC。临终结局包括临终关怀的使用、临终关怀登记≥3天、生命最后30天内重症监护病房（ICU）的使用以及生命最后14天内化疗的使用。我们使用Cox回归模型，通过交互项在乘法尺度上以及使用交互相对风险（RERI）、归因比例（AP）和协同指数（SI）在加法尺度上评估专科PC与种族之间所有结局的交互作用是否存在。
经过1:1匹配后，纳入了13931名接受暴露组和13931名未接受暴露组的老年人，其中13.4%为黑人。与未接受专科PC的老年人相比，接受专科PC的黑人和NHW老年人更有可能使用临终关怀（黑人：71.0%对52.4%，p<0.0001；NHW：80.4%对63.2%，p<0.0001），临终关怀登记≥3天（黑人：65.5%对44.0%，p<0.0001；NHW：74.2%对52.6%，p<0.0001），并且在临终时较少使用ICU（黑人：16.4%对19.9%，p=0.0058；NHW：11.3%对14.0%，p<0.0001）或化疗（黑人：1.2%对2.4%，p=0.0075；NHW：1.4%对3.4%，p<0.0001）。没有证据表明任何结局存在乘法交互作用或加法交互作用。
在患有转移性癌症的老年人中，没有证据表明黑人和NHW患者在专科PC效果上存在异质性，这表明专科PC疗效的差异不是临终关怀中种族差异的原因。
