title: Association of age, gender, and race with intensity of end-of-life care for Medicare beneficiaries with cancer.
abstract: OBJECTIVE
  To measure intensity of end-of-life (EOL) care for Medicare cancer patients and variations in care by age, gender, and race.
  
  
  METHODS
  This retrospective cohort analysis of Medicare claims (20% sample) examined 235,821 Medicare Parts A and B fee-for-service patients dying with poor-prognosis cancers between 2003 and 2007. Logistic regression models quantified associations between care intensity and age, gender, and race. Measures included hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, in-hospital deaths, late-life chemotherapy administration, overall and late hospice enrollment within six months of death.
  
  
  RESULTS
  Within 30 days of death, 61.3% of patients were hospitalized, 10.2% were hospitalized more than once, 10.2% visited an ED more than once, 23.7% had ICU admissions, and 28.8% died in-hospital. Within two weeks of death, 6% received chemotherapy. In their final six months, 55.2% accessed hospice, 15.1% within three days of death. Older age (≥75 versus <75) was associated with lower odds ratios (ORs) of 0.49 to 0.89 for aggressive care, and an OR of 0.92 (95% CI 0.89-0.95) for late hospice enrollment. Female gender was associated with lower ORs (0.82 to 0.86) for aggressive care, and an OR of 0.84 (95% CI 0.81-0.86) for late hospice enrollment. Black (versus nonblack) race was associated with higher ORs (1.08 to 1.38) for aggressive acute care, lower ORs for late chemotherapy, OR 0.76 (95% CI 0.71-0.81), and late hospice enrollment, OR 0.81 (95% CI 0.76-0.86).
  
  
  CONCLUSIONS
  Seniors dying with poor-prognosis cancer experience high-intensity care with rates varying by age, gender, and race.
authors.affiliation: Maine Medical Center Research Institute, Maine Medical Center, Portland, Maine, USA. MIESFS@mmc.org
authors.forename: Susan
authors.initials: S
authors.lastname: Miesfeldt
authors.forename: Kimberly
authors.initials: K
authors.lastname: Murray
authors.forename: Lee
authors.initials: L
authors.lastname: Lucas
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.forename: David
authors.initials: D
authors.lastname: Goodman
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016344:Medicare Part A; D016345:Medicare Part B; D009369:Neoplasms; D044469:Racial Groups; D012189:Retrospective Studies; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States