Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life.

Autor: Jia Z; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA. Zhimeng_jia@dfci.harvard.edu., Leiter RE; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Sanders JJ; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Ariadne Labs, Boston, MA, USA., Sullivan DR; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA.; Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Healthcare System, Portland, OR, USA., Gozalo P; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA., Bunker JN; Division of General Internal Medicine and Geriatrics, School of Medicine, Health & Science University, Portland, OR, USA., Teno JM; Division of General Internal Medicine and Geriatrics, School of Medicine, Health & Science University, Portland, OR, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2022 Mar; Vol. 37 (4), pp. 737-744. Date of Electronic Publication: 2021 Apr 26.
DOI: 10.1007/s11606-021-06794-6
Abstrakt: Background: Asian Americans are the fastest-growing ethnic minority in the USA, but we know little about the end-of-life care for this population.
Objective: Compare invasive mechanical ventilation (IMV) use between older Asian and White decedents with hospitalization in the last 30 days of life.
Design: Population-based retrospective cohort study.
Participants: A 20% random sample of 2000-2017 Medicare fee-for-service decedents who were 66 years or older and had a hospitalization in the last 30 days of life.
Exposure: White and Asian ethnicity as collected by the Social Security Administration.
Main Measures: We identified IMV using validated procedural codes. We compared IMV use between Asian and White fee-for-service decedents using random-effects logistic regression analysis, adjusting for sociodemographics, admitting diagnosis, comorbidities, and secular trends.
Key Results: From 2000 to 2017, we identified 2.1 million White (54.5% female, 82.4±8.1 mean age) and 28,328 Asian (50.8% female, 82.6±8.1 mean age) Medicare fee-for-service decedents hospitalized in the last 30 days. Compared to White decedents, Asian fee-for-service decedents have an increased adjusted odds ratio (AOR) of 1.42 (95%CI: 1.38-1.47) for IMV. In sub-analyses, Asians' AOR for IMV differed by admitting diagnoses (cancer AOR=1.32, 95%CI: 1.15-1.51; congestive heart failure AOR=1.75, 95%CI: 1.47-2.08; dementia AOR=1.93, 95%CI: 1.70-2.20; and chronic obstructive pulmonary disease AOR=2.25, 95%CI: 1.76-2.89).
Conclusions: Compared to White decedents, Asian Medicare decedents are more likely to receive IMV when hospitalized at the end-of-life, especially among patients with non-cancer admitting diagnoses. Future research to better understand the reasons for these differences and perceived quality of end-of-life care among Asian Americans is urgently needed.
(© 2021. Society of General Internal Medicine.)
Databáze: MEDLINE
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