title: Low socioeconomic status is associated with more aggressive end-of-life care for working-age terminal cancer patients.
abstract: BACKGROUND
  The relationship between low socioeconomic status (SES) and aggressiveness of end-of-life (EOL) care in cancer patients of working age (older than 18 years and younger than 65 years) is not clear. We assessed the association between aggressiveness of EOL care and differences in SES among working-age terminal cancer patients from Taiwan between 2009 and 2011.
  
  
  METHODS
  A total of 32,800 cancer deaths were identified from the Taiwan National Health Insurance Research Database. The indicators of aggressive EOL care (chemotherapy, more than one emergency room [ER] visit or hospital admission, more than 14 days of hospitalization, intensive care unit [ICU] admission, and death in an acute care hospital) in the last month of life were examined. The associations between SES and the indicators were explored.
  
  
  RESULTS
  Up to 81% of the cancer deaths presented at least one indicator of aggressive EOL care. Those who were aged 35-44 years and male, had low SES, had metastatic malignant disease, lived in urban areas, or were in hospitals with more abundant health care resources were more likely to receive aggressive EOL care. In multilevel logistic regression analyses, high-SES cancer deaths had less chemotherapy (p < .001), fewer ER visits (p < .001), fewer ICU admissions (p < .001), and lower rates of dying in acute hospitals (p < .001) compared with low-SES cancer deaths.
  
  
  CONCLUSIONS
  Working-age terminal cancer patients in Taiwan received aggressive EOL care. EOL cancer care was even more aggressive in those with low SES. Public health strategies should continue to focus on low-SES patients to provide them with better EOL cancer care.
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China.
authors.forename: Chin-Chia
authors.initials: CC
authors.lastname: Wu
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China.
authors.forename: Wen-Yao
authors.initials: WY
authors.lastname: Yin
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China.
authors.forename: Shiun-Yang
authors.initials: SY
authors.lastname: Juang
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Yu
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Surgery, Center for Clinical Epidemiology and Biostatistics, and Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China hematcd2@hotmail.com.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012923:Social Class; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care
keywords: Cancer; End-of-life care; Socioeconomic status; Working age; Young adults