title: Racial and ethnic differences in hospice use among patients with heart failure.
abstract: BACKGROUND
  Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure.
  
  
  METHODS
  On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of race and ethnicity on hospice entry for patients with heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors.
  
  
  RESULTS
  In unadjusted analysis, blacks (odds ratio [OR], 0.52) and Hispanics (0.43) used hospice care for heart failure less than whites. Racial and ethnic differences in patients who received hospice care for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted OR for blacks, 0.59; 95% confidence interval, 0.47-0.73; and adjusted OR for Hispanics, 0.49; 95% confidence interval, 0.37-0.66; compared with whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice use.
  
  
  CONCLUSIONS
  In a national sample of Medicare beneficiaries with heart failure, blacks and Hispanics used hospice care for heart failure less than whites after adjustment for individual and market factors. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior is needed.
authors.affiliation: Hebrew SeniorLife Institute for Aging Research, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA. janegivens@hrca.harvard.edu
authors.forename: Jane L
authors.initials: JL
authors.lastname: Givens
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Chao
authors.initials: C
authors.lastname: Zhou
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Emanuel
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*