Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients.
OBJECTIVE
Cancer is the leading cause of death among Asian Americans, yet little is known about their use of hospice care. We examined hospice use by Asian patients compared with white patients, and assessed whether utilization differs among those born in the United States or abroad.


METHODS
We studied Asian and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results (SEER) Program who died of primary lung, colorectal, prostate, breast, gastric, or liver cancer between 1988 and 1998. We used logistic regression to determine the effects of race/ethnicity and birthplace on hospice use, adjusting for demographic characteristics, managed care insurance, year of diagnosis, tumor stage at diagnosis, and tumor registry.


RESULTS
Of the 184,081 patients, 5% (n = 8614) were Asian Americans, of whom 45% (n = 3847) were foreign born. Compared with whites, Asian Americans were more likely to be male, married, and enrolled in managed care. Compared with U.S.-born Asian Americans, foreign-born Asian Americans were more likely to reside in low-income areas. After adjustment, patients who were Asian American (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.62 to 0.73) and born abroad (OR = 0.90; 95% CI: 0.86 to 0.94) were less likely to use hospice care than were white patients. These results were consistent across the six cancer diagnoses that were examined.


CONCLUSIONS
Older Asian Americans dying of cancer, especially those who are born abroad, are less likely than white patients to use hospice care at the end of life. Additional research is needed to understand the reasons for these differences and to eliminate potential barriers to hospice care.
Ngo-Metzger
Quyen
Q
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, Boston, USA. Qhngo@uci.edu
McCarthy
Ellen P
EP
Burns
Risa B
RB
Davis
Roger B
RB
Li
Frederick P
FP
Phillips
Russell S
RS
D000367:Age Factors; D000368:Aged; D001213:Asian / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality*; D010139:Pacific Islands / Q000208:ethnology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data*