title: Disparities in end of life care for elderly lung cancer patients.
abstract: The objective of this study was to examine geographic and race/ethnic disparities in access to end of life care among elderly patients with lung cancer. The study sample consisted of 91,039 Medicare beneficiaries with lung cancer who died in 2008. The key outcome measures included the number of emergency room visits, the number of inpatient admissions and the number of intensive care unit (ICU) days in the last 90 days of life, hospice care ever used and hospice enrollment within the last 3 days of life. Medicare beneficiaries with lung cancer residing in rural, remote rural, and micropolitan areas had more ER visits in the last 90 days of life as compared to urban residents. Urban residents however, had more ICU days in the last 90 days of life and were more likely to have ever used hospice as compared to residents of rural, remote rural and micropolitan counties. Racial minority lung cancer patients had more ICU days, ER visits and inpatient days than non-Hispanic White patients, and also were less likely to have ever used hospice care or be enrolled in hospice in the last 3 days of life. Lung cancer patients with very low socioeconomic status (SES) were less likely to ever use hospice or be enrolled in hospice care in the last 3 days of life, as compared to those who had very high SES. Geographic, racial and socioeconomic disparities in end of life care call for targeted efforts to address access barriers for these groups of patients.
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-4350, USA, pnayar@unmc.edu.
authors.forename: Preethy
authors.initials: P
authors.lastname: Nayar
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
authors.forename: Eugene
authors.initials: E
authors.lastname: Boilesen
authors.forename: Hongmei
authors.initials: H
authors.lastname: Wang
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: Monirul
authors.initials: M
authors.lastname: Islam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data