TY - JOUR
T1 - Hospice Utilization in the United States
T2 - A Prospective Cohort Study Comparing Cancer and Noncancer Deaths
AU - Cagle, John G.
AU - Lee, Joonyup
AU - Ornstein, Katherine A.
AU - Guralnik, Jack M.
N1 - Funding Information:
We would like to thank John T. Lemm, MD, and Karthik Raghunathan, MD, who read and provided helpful feedback on an early draft of this article. U.S. Department of Health and Human Services National Institutes of Health National Institute on Aging NIA U01AG009740. The authors have declared no conflicts of interest for this article. All authors contributed to the study design, analysis, interpretation of data, and development of the manuscript. John G. Cagle takes full responsibility for the accuracy of the information reported in this report. Funders had no role in study development, execution, or dissemination of results. Health and Retirement Study data are publicly available. The protocol and data are produced and distributed by the University of Michigan with funding from the National Institute on Aging (NIA U01AG009740), http://hrsonline.isr.umich.edu.
Funding Information:
Funders had no role in study development, execution, or dissemination of results. Health and Retirement Study data are publicly available. The protocol and data are produced and distributed by the University of Michigan with funding from the National Institute on Aging (NIA U01AG009740), http://hrsonline.isr.umich.edu .
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2020/4/1
Y1 - 2020/4/1
N2 - OBJECTIVES: Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN: We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non-cancer deaths. SETTING: Study data were provided by a population-based sample of older adults from the U.S. PARTICIPANTS: We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS: Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS: Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR =.79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR =.77) were associated with hospice utilization. CONCLUSION: Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020.
AB - OBJECTIVES: Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN: We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non-cancer deaths. SETTING: Study data were provided by a population-based sample of older adults from the U.S. PARTICIPANTS: We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS: Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS: Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR =.79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR =.77) were associated with hospice utilization. CONCLUSION: Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020.
KW - Health and Retirement Study
KW - end-of-life care
KW - healthcare utilization
KW - hospice
UR - http://www.scopus.com/inward/record.url?scp=85077211389&partnerID=8YFLogxK
U2 - 10.1111/jgs.16294
DO - 10.1111/jgs.16294
M3 - Article
C2 - 31880312
AN - SCOPUS:85077211389
SN - 0002-8614
VL - 68
SP - 783
EP - 793
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 4
ER -