title: Determinants of death in the hospital among older adults.
abstract: OBJECTIVE
  To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.
  
  
  METHODS
  Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.
  
  
  METHODS
  The Health and Retirement Study, a longitudinal nationally representative cohort of older adults.
  
  
  METHODS
  People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled.
  
  
  METHODS
  In-hospital death.
  
  
  RESULTS
  Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.
  
  
  CONCLUSIONS
  Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.
authors.affiliation: Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA. amy.kelley@mssm.edu
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sarkisian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors
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