title: The association between individual income and aggressive end-of-life treatment in older cancer decedents in Taiwan.
abstract: OBJECTIVE
  To examine the association of individual income and end of life (EOL) care in older cancer decedents in Taiwan.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  National Health Insurance Research Database (NHIRD) in Taiwan.
  
  
  METHODS
  28,978 decedents >65 years were diagnosed with cancer and died during 2009-2011 in Taiwan. Of these decedents, 10941, 16535, and 1502 were categorized by individual income as having low, moderate, and high SES, respectively.
  
  
  METHODS
  Indicators of aggressiveness of EOL care: chemotherapy use before EOL, more than one emergency department (ER) visit, more than one hospital admission, hospital length of stay >14 days, intensive care unit (ICU) admission, and dying in a hospital.
  
  
  RESULTS
  Low individual income was associated with more aggressive EOL treatment (estimate -0.30 for moderate income, -0.27 for high income, both p<0.01). The major source of aggressiveness was the tendency for older decedents with low income to die in the acute care hospital. The indicators had an increasing trend from 2009 to 2011, except for hospital stay >14 days.
  
  
  CONCLUSIONS
  Low individual income is associated with more aggressive EOL treatment in older cancer decedents. Public health providers should make available appropriate education and hospice resources to these decedents and their families, to reduce the amount of aggressive terminal care such decedents receive.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
authors.forename: Yeh-Ting
authors.initials: YT
authors.lastname: Hung
authors.affiliation: Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
authors.forename: Shiun-Yang
authors.initials: SY
authors.lastname: Juang
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017051:Hospice Care / Q000523:psychology / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan; D013727:Terminal Care / Q000706:statistics & numerical data*