Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context
Summary: Background: Given significant morbidity and mortality associated with oesophageal cancer, supportive, high-quality end-of-life care is critical. Most patients with advanced cancer prefer to die at home, but incongruence between preferred and actual place of death is common. Here, we examin...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X22002186 |
| _version_ | 1797946271592349696 |
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| author | Simar S. Bajaj Bhav Jain Alexandra L. Potter Edward Christopher Dee Chi-Fu Jeffrey Yang |
| author_facet | Simar S. Bajaj Bhav Jain Alexandra L. Potter Edward Christopher Dee Chi-Fu Jeffrey Yang |
| author_sort | Simar S. Bajaj |
| collection | DOAJ |
| description | Summary: Background: Given significant morbidity and mortality associated with oesophageal cancer, supportive, high-quality end-of-life care is critical. Most patients with advanced cancer prefer to die at home, but incongruence between preferred and actual place of death is common. Here, we examined trends and disparities in location of death among patients with oesophageal cancer. Methods: Using the Centers for Disease Control and Prevention Wide-Range Online Data for Epidemiologic Research database, we utilized multinomial logistic regression to assess associations between sociodemographic characteristics and location of death for patients with oesophageal cancer (n = 237,063). Additionally, we utilized linear regression models to evaluate the significance of changes in location of death trends over time and disparities in the relative change in location of death trends across sociodemographic groups. Findings: From 2003 to 2019, there was a decrease of deaths in hospitals, nursing homes, and outpatient medical facilities/emergency departments and an increase of deaths at home and in hospice. Relative to White decedents, Black and Asian decedents were less likely to die at home (relative risk ratio (RRR): 0.58 [95% confidence interval (CI): 0.56–0.60], RRR: 0.57 [95% CI: 0.53–0.61]) and in hospice (RRR: 0.67 [95% CI: 0.64–0.71], RRR: 0.49 [95% CI: 0.43–0.55]) when compared to the hospital. Similar disparities were noted for American Indian and Alaska Native (AIAN) decedents. These disparities persisted even upon stratifying by the number of listed causes of death, a proxy for severity of illness. Time trend analysis indicated that increases in deaths in hospice over time occurred at a slower rate for AIAN and Asian decedents relative to White decedents. Interpretation: 2 in 5 patients with oesophageal cancer die at home, with an increasing proportion dying at home and in hospice—in line with general patient preferences. However, location of death disparities have largely persisted over time among racial and ethnic minority groups. Our findings suggest the importance of improving access to advance care planning and delivering tailored, person-centred interventions. Funding: None. |
| first_indexed | 2024-04-10T21:08:23Z |
| format | Article |
| id | doaj.art-113ba297b5914f878dce888bc48ff322 |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-04-10T21:08:23Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-113ba297b5914f878dce888bc48ff3222023-01-21T04:22:01ZengElsevierThe Lancet Regional Health. Americas2667-193X2023-01-0117100401Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in contextSimar S. Bajaj0Bhav Jain1Alexandra L. Potter2Edward Christopher Dee3Chi-Fu Jeffrey Yang4Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USADivision of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USADivision of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USADepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USADivision of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Corresponding author. Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.Summary: Background: Given significant morbidity and mortality associated with oesophageal cancer, supportive, high-quality end-of-life care is critical. Most patients with advanced cancer prefer to die at home, but incongruence between preferred and actual place of death is common. Here, we examined trends and disparities in location of death among patients with oesophageal cancer. Methods: Using the Centers for Disease Control and Prevention Wide-Range Online Data for Epidemiologic Research database, we utilized multinomial logistic regression to assess associations between sociodemographic characteristics and location of death for patients with oesophageal cancer (n = 237,063). Additionally, we utilized linear regression models to evaluate the significance of changes in location of death trends over time and disparities in the relative change in location of death trends across sociodemographic groups. Findings: From 2003 to 2019, there was a decrease of deaths in hospitals, nursing homes, and outpatient medical facilities/emergency departments and an increase of deaths at home and in hospice. Relative to White decedents, Black and Asian decedents were less likely to die at home (relative risk ratio (RRR): 0.58 [95% confidence interval (CI): 0.56–0.60], RRR: 0.57 [95% CI: 0.53–0.61]) and in hospice (RRR: 0.67 [95% CI: 0.64–0.71], RRR: 0.49 [95% CI: 0.43–0.55]) when compared to the hospital. Similar disparities were noted for American Indian and Alaska Native (AIAN) decedents. These disparities persisted even upon stratifying by the number of listed causes of death, a proxy for severity of illness. Time trend analysis indicated that increases in deaths in hospice over time occurred at a slower rate for AIAN and Asian decedents relative to White decedents. Interpretation: 2 in 5 patients with oesophageal cancer die at home, with an increasing proportion dying at home and in hospice—in line with general patient preferences. However, location of death disparities have largely persisted over time among racial and ethnic minority groups. Our findings suggest the importance of improving access to advance care planning and delivering tailored, person-centred interventions. Funding: None.http://www.sciencedirect.com/science/article/pii/S2667193X22002186End-of-life careLocation of deathRaceEthnicityDisparitiesHealth Equity |
| spellingShingle | Simar S. Bajaj Bhav Jain Alexandra L. Potter Edward Christopher Dee Chi-Fu Jeffrey Yang Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context The Lancet Regional Health. Americas End-of-life care Location of death Race Ethnicity Disparities Health Equity |
| title | Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context |
| title_full | Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context |
| title_fullStr | Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context |
| title_full_unstemmed | Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context |
| title_short | Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context |
| title_sort | racial and ethnic disparities in end of life care for patients with oesophageal cancer death trends over timeresearch in context |
| topic | End-of-life care Location of death Race Ethnicity Disparities Health Equity |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X22002186 |
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