TY - JOUR
T1 - Live Discharge from Hospice Due to Acute Hospitalization
T2 - The Role of Neighborhood Socioeconomic Characteristics and Race/Ethnicity
AU - Russell, David
AU - Luth, Elizabeth A.
AU - Ryvicker, Miriam
AU - Bowles, Kathryn H.
AU - Prigerson, Holly G.
N1 - Publisher Copyright: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes. Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization. The authors also explore the moderating role of race/ethnicity in any observed relationship. Research Design: Retrospective cohort study using electronic medical records of hospice patients (N=17,290) linked with neighborhood-level socioeconomic data (N= 55 neighborhoods). Multilevel models were used to identify the independent significance of patient and neighborhood-level characteristics for risk of live discharge because of acute hospitalization. Results: Compared with the patients in the most well-educated and affluent sections of New York City (quartile [Q]4), the odds of live discharge from hospice because of acute hospitalization were greater among patients who resided in neighborhoods where lower proportions of residents held college degrees (Q1 adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.06-1.75; Q2 AOR, 1.41; 95% CI, 1.07-1.84) and median household incomes were lower (Q1 AOR, 1.42; 95% CI, 1.10-1.85]; Q2 AOR, 1.43; 95% CI, 1.10-1.85; Q3 AOR, 1.39; 95% CI, 1.07-1.80). However, these observed relationships were not equally distributed by patient race/ethnicity; the association of neighborhood socioeconomic disadvantage and risk for live discharge was significantly lower among Hispanic compared with white patients. Conclusions: Findings demonstrate neighborhood socioeconomic disadvantage poses a significant risk for live discharge from hospice. Additional research is needed to clarify the social mechanisms underlying this association, including greater attention to the experiences of hospice patients from under-represented racial/ethnic groups.
AB - Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes. Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization. The authors also explore the moderating role of race/ethnicity in any observed relationship. Research Design: Retrospective cohort study using electronic medical records of hospice patients (N=17,290) linked with neighborhood-level socioeconomic data (N= 55 neighborhoods). Multilevel models were used to identify the independent significance of patient and neighborhood-level characteristics for risk of live discharge because of acute hospitalization. Results: Compared with the patients in the most well-educated and affluent sections of New York City (quartile [Q]4), the odds of live discharge from hospice because of acute hospitalization were greater among patients who resided in neighborhoods where lower proportions of residents held college degrees (Q1 adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.06-1.75; Q2 AOR, 1.41; 95% CI, 1.07-1.84) and median household incomes were lower (Q1 AOR, 1.42; 95% CI, 1.10-1.85]; Q2 AOR, 1.43; 95% CI, 1.10-1.85; Q3 AOR, 1.39; 95% CI, 1.07-1.80). However, these observed relationships were not equally distributed by patient race/ethnicity; the association of neighborhood socioeconomic disadvantage and risk for live discharge was significantly lower among Hispanic compared with white patients. Conclusions: Findings demonstrate neighborhood socioeconomic disadvantage poses a significant risk for live discharge from hospice. Additional research is needed to clarify the social mechanisms underlying this association, including greater attention to the experiences of hospice patients from under-represented racial/ethnic groups.
KW - Hospice
KW - Neighborhood socioeconomic disadvantage
KW - New York city
KW - Race and ethnicity
KW - Social disparities
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U2 - https://doi.org/10.1097/MLR.0000000000001278
DO - https://doi.org/10.1097/MLR.0000000000001278
M3 - Article
C2 - 31876664
SN - 0025-7079
JO - Medical care
JF - Medical care
ER -