Quality of End‐of‐Life Care Among Rural Medicare Beneficiaries With Colorectal Cancer

Journal of Rural Health - Tập 30 Số 4 - Trang 397-405 - 2014
Shinobu Watanabe‐Galloway1, Wanqing Zhang2, Kate Watkins1, KM Monirul Islam3, Preethy Nayar3, Eugene Boilesen4, Lina Lander1, Hongmei Wang3, Fang Qiu5
1Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
2Department of Allied Health Sciences; School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
3Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
4Center for Collaboration on Research Design and Analysis College of Public Health University of Nebraska Medical Center Omaha Nebraska
5Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska

Tóm tắt

AbstractBackgroundAlthough previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end‐of‐life indicators among cancer survivors.MethodsMedicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural‐urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death.ResultsAbout 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU.ConclusionsEvidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds.

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Journal of Rural Health

Tập 30 Số 4

397-405

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