Abstract
Purpose
Cancer is the leading cause of death among Asian Americans, yet little is known about
their use of hospice care. We examined hospice use by Asian patients compared with
white patients, and assessed whether utilization differs among those born in the United
States or abroad.
Methods
We studied Asian and white Medicare beneficiaries registered in the Surveillance,
Epidemiology, and End Results (SEER) Program who died of primary lung, colorectal,
prostate, breast, gastric, or liver cancer between 1988 and 1998. We used logistic
regression to determine the effects of race/ethnicity and birthplace on hospice use,
adjusting for demographic characteristics, managed care insurance, year of diagnosis,
tumor stage at diagnosis, and tumor registry.
Results
Of the 184,081 patients, 5% (n = 8614) were Asian Americans, of whom 45% (n = 3847)
were foreign born. Compared with whites, Asian Americans were more likely to be male,
married, and enrolled in managed care. Compared with U.S.-born Asian Americans, foreign-born
Asian Americans were more likely to reside in low-income areas. After adjustment,
patients who were Asian American (odds ratio [OR] = 0.67; 95% confidence interval
[CI]: 0.62 to 0.73) and born abroad (OR = 0.90; 95% CI: 0.86 to 0.94) were less likely
to use hospice care than were white patients. These results were consistent across
the six cancer diagnoses that were examined.
Conclusion
Older Asian Americans dying of cancer, especially those who are born abroad, are less
likely than white patients to use hospice care at the end of life. Additional research
is needed to understand the reasons for these differences and to eliminate potential
barriers to hospice care.
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References
- Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden.Cancer. 2002; 94: 2766-2792
- Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends.J Natl Cancer Inst. 2001; 93: 824-842
- Cancer incidence and mortality 1973–1995.Cancer. 1998; 82: 1197-1207
- Haynes M.A. Smedley B.D. The Unequal Burden of Cancer An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. National Academy Press, Washington, DC1999: 4-8
- Hewitt M. Simone J.V. Ensuring Quality Cancer Care. National Academy Press, Washington, DC1999: 10-12
Statistical Abstracts of the United States, 1995. Washington, DC: U.S. Bureau of the Census, U.S. Government Printing Office; 1995:19
- Factors associated with breast and cervical cancer screening practices among Vietnamese American women.Cancer Detect Prev. 1997; 21: 510-521
- Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States.Am J Prev Med. 2000; 18: 62-68
- Breast cancer screening among Cambodian American Women.Cancer Detect Prev. 2000; 24: 549-563
- Asian American and Pacific Islander breast and cervical carcinoma screening rates and Healthy People 2000 objectives.Cancer. 2000; 89: 696-705
- Asian breast cancer survival in the US.Int J Epidemiol. 2001; 30: 976-982
- Differences in treatment patterns for localized breast carcinoma among Asian/Pacific Islander women.Cancer. 2002; 95: 2268-2275
- Alternative therapies used by women with breast cancer in four ethnic populations.J Natl Cancer Inst. 2000; 92: 42-47
- Breast cancer characteristics of Vietnamese women in the Greater San Francisco Bay Area.West J Med. 2002; 176: 87-91
- Cancer prevention and control among Asian and Pacific Islander Americans.Cancer. 1998; 83: 1856-1864
- Characteristics of hospice care users.Adv Data. 1998; 229: 1-16
- Hospice access and use by African Americans.Soc Work. 1999; 44: 549-559
The Medicare Hospice Benefit. Baltimore, MD: Health Care Financing Administration; March 2000. Publication No. 02154. Available at: http://www.medicare.gov/publications/pubs/pdf/02154.pdf. Accessed February 11, 2003
- A controlled trial to improve care for seriously ill hospitalized patients.JAMA. 1995; 274: 1591-1598
- Understanding economic and other burdens of terminal illness; the experience of patients and their caregivers.Ann Intern Med. 2000; 132: 451-459
- Potential for cancer related health services research using a linked Medicare-tumor registry database.Med Care. 1993; 31: 732-748
Cancer Surveillance Research Implementation Plan. Bethesda, MD: Surveillance Implementation Group (SIG), National Cancer Institute, National Institutes of Health; March 1999. Available at: http://cancercontrol.cancer.gov/sig/. Accessed June 5, 2002
- Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations.Med Care. 2002; 40: IV19-IV25
- Overview of the SEER-Medicare data content, research applications, and generalizability the United States elderly population.Med Care. 2002; 40: IV3-IV18
- Overcoming the absence of socioeconomic data in medical records.Am J Public Health. 1992; 92: 703-710
- Effects of race and income on mortality and use of services among Medicare beneficiaries.N Engl J Med. 1996; 335: 791-799
SAS/STAT User’s Guide. Version 6. 4th ed. Vol. 1–2. Cary, NC: SAS Institute, Inc.; 1992
- Survival of Medicare patients after enrollment in hospice programs.N Engl J Med. 1996; 335: 172-178
- Do Medicare HMOs and Medicare FFS differ in their use of the Medicare Hospice Benefit?.Hosp J. 1999; 14: 1-12
- Barriers to hospice care among older patients dying with lung and colorectal cancer.J Clin Oncol. 2003; 21: 728-735
- Deterrents to access and service for blacks and Hispanics.Hosp J. 1995; 10: 65-83
- Minority representation, prevalence of symptoms, and utilization of services in a large metropolitan hospice.J Pain Symptom Manage. 2001; 21: 290-297
- Hospice and minorities.Hosp J. 1996; 11: 49-70
- The African American experience.Hosp J. 1995; 10: 15-18
- Hispanic American elders.Hosp J. 1995; 10: 35-49
- Hospice care for minorities.Am J Hosp Care. 1989; 6: 13-21
- Hospice concept and implementation in the Black community.J Community Health Nurs. 1986; 3: 137-144
General Demographic Characteristics for the White Population, General Demographic Characteristics for the Asian Population. U.S. Census Bureau, 2002. Available at: http://www.census.gov/population/cen2000/phc-t15/tab01.pdf http://www.census.gov/population/cen2000/phc-t15/tab04.pdf. Accessed February 14, 2003
- Awareness of hospice services.Public Health Rep. 1989; 104: 178-182
- Rx for dying.N Engl J Med. 1988; 318: 376-378
- Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988.Am J Public Health. 1995; 85: 352-356
- The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain.Pain. 1996; 66: 9-12
- Smedley B.D. Stith A.Y. Nelson A.R. Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care. National Academy Press, Washington, DC2002: 478-480
- Barriers to optimum end-of-life care for minority patients.J Am Geriatr Soc. 2002; 50: 182-190
- Report from the national task force on access to hospice care by minority groups.Hosp J. 1995; 10: 1-9
- Asian and Pacific Islander cultural values.Health Soc Work. 1998; 23: 116-126
- Ethical decision making and patient autonomy.Chest. 2000; 118: 1172-1182
Patients’ right to know in Japan. Lancet. 1990;336:1309-1310
- Medical ethics the Japanese way.Hastings Cent Rep. 1985; 15: 21-24
- Hospice care in Japan.Am J Hosp Palliat Care. 1993; 10: 35-40
- Understanding cultural difference in caring for dying patients.West J Med. 1995; 163: 244-249
- Ethnicity and attitudes towards life sustaining technology.Soc Sci Med. 1999; 48: 1779-1789
- Ethnicity and attitudes toward patient autonomy.JAMA. 1995; 274: 820-825
- Cross-cultural similarities and differences in attitudes about advance care planning.J Gen Intern Med. 2002; 17: 48-57
Lauderdale DS, Goldberg J. The expanded racial and ethnic codes in the Medicare data files: their completeness of coverage and accuracy. Am J Public Health. 1996;86:712–716
- The reliability of racial classification in hospital discharge abstract data.Am J Public Health. 1994; 84: 1018-1021
- Comparison of methods for classifying Hispanic ethnicity in a population-based cancer registry.Am J Epidemiol. 1999; 149: 1063-1071
- Accuracy of racial classification of Vietnamese patients in a population-based cancer registry.Ethn Dis. 1998; 8: 219-227
- Factors associated with missing birthplace information in a population-based cancer registry.Ethn Dis. 2001; 11: 598-605
Koenig BA. Cultural diversity in decision making about care at the end of life. In: Institute of Medicine, ed. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press; 1997:363–382
- The hard task of improving the quality of care at the end of life.Arch Intern Med. 2000; 160: 743-747
- End-of Life-Care Consensus Panel. Strategies for culturally effective end-of life care.Ann Intern Med. 2002; 136: 673-679
- Comparing the quality of death for hospice and non-hospice cancer patients.Med Care. 1988; 26: 177-182
Article info
Publication history
Accepted:
March 10,
2003
Received:
September 13,
2002
Footnotes
☆Dr. McCarthy is the recipient of a First Independent Research Support and Transition Award 5R29 CA79052 funded by the National Cancer Institute, Bethesda, Maryland. Drs. Ngo-Metzger and Li are supported by the Asian American Network for Cancer Awareness, Research, and Training (Cooperative Agreement Number U01 CA86322 from the National Cancer Institute).
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
