Racial/Ethnic Disparities in Hospitalization Outcomes by Palliative Care Utilization and Trends Among Women With Metastatic Breast Cancer in the United States.

IF 4.7 3区 医学 Q1 ONCOLOGY JCO oncology practice Pub Date : 2024-10-15 DOI:10.1200/OP.24.00434
Inimfon Jackson, Qian Lu, Debasish Tripathy
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Abstract

Purpose: We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization.

Methods: Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use.

Results: Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility.

Conclusion: Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.

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美国患有转移性乳腺癌的妇女在住院治疗结果中使用姑息治疗的种族/族裔差异及趋势。
目的:我们研究了姑息治疗利用率的趋势、诊断为转移性乳腺癌(MBC)的成年女性住院治疗结果的种族/民族差异以及姑息治疗利用率的效应修正:利用美国医疗保健研究与质量局赞助的医疗保健成本与利用项目--全国住院患者样本数据库,对2016年至2020年的患者进行了回顾性队列分析。回归分析用于评估姑息治疗趋势,以及种族/民族与院内死亡率、住院时间、住院总费用和出院处置之间的关联。根据姑息关怀的使用情况进行了分层分析:研究人群中的姑息治疗就诊率从2016年的16.4%增至2020年的20.3%。与白人患者相比,黑人(调整后几率比 [AOR],1.25 [95% CI,1.16 至 1.34])和西班牙裔(AOR,1.12 [95% CI,1.01 至 1.23])女性乳腺癌患者的院内死亡率较高。在接受姑息治疗的患者中,黑人的院内死亡率与白人相似(AOR,1.08 [95% CI,0.97-1.20])。与白人妇女相比,黑人妇女的住院时间更长。虽然与白人妇女相比,黑人妇女出院后前往短期/专业护理机构的几率(AOR,0.98 [95% CI,0.92 至 1.04])与常规出院的几率相似,但接受姑息治疗的黑人出院后前往护理机构的几率要低 19% (95% CI,0.70 至 0.95):我们的研究结果强调了在乳腺癌患者中使用姑息治疗的重要性,并强调有必要提高人们对姑息治疗益处的认识,尤其是在少数民族人群中。还需要进一步的研究来探索缩小现有差距的方法,并测试这些干预措施对护理指标和患者预后的影响。
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CiteScore
6.40
自引率
7.50%
发文量
518
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