| Community Supply of Hospice: Does Wealth Play A Role? | |
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MedLine Citation:
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PMID: 21429702 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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CONTEXT: Hospice is underused by older, rural, and minority populations. OBJECTIVE: Because local availability of hospice is an important predictor of use, we aimed to identify geographic variation in hospice supply and examine its community-level determinants, including wealth. METHODS: This was an observational geographic study using the 2008 National Hospice Data set and the 2000 U.S. census data for 3140 U.S. counties. Our outcome of interest was hospice supply defined according to the number of hospice programs (regardless of level of care) servicing each county. We used binomial multivariable regression to test the relationship between supply and log-transformed counts of population, African Americans, Hispanics, residents aged 65, and high school educated residents as well as area, median household income, and certificate of need status. RESULTS: Hospice availability varied greatly across the United States, with an unadjusted mean of 24.3 hospice programs servicing each county (standard deviation 19.7, range 0-160). After adjusting for all covariates, median household income (IRR= Incidence Rate Ratio 1.03, P<0.001), population count (IRR 17.9, P<0.001), count of African Americans (IRR 1.26, P<0.001) and elderly adults (IRR 2.81, P<0.001) positively predicted supply, whereas area (IRR 0.84, P<0.001), certificate of need status (IRR 0.89, P<0.001), count of Hispanics (IRR 0.86, P<0.01), and high school educated (IRR 0.03, P<0.001) negatively predicted supply. CONCLUSIONS: There is gross variation in hospice supply that can be explained by community wealth, population density, age, ethnicity, and race. To address disparate utilization of hospice, the relationship between wealth and availability will need to be better understood. |
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Authors:
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Maria J Silveira; Stephen R Connor; Susan D Goold; Lawrence F McMahon; Chris Feudtner |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-22 |
Journal Detail:
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Title: Journal of pain and symptom management Volume: - ISSN: 1873-6513 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8605836 Medline TA: J Pain Symptom Manage Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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VA Health Services Research and Development Center of Excellence (M.J.S.), and Division of General Medicine (M.J.S., S.D.G., L.F.M.) and Bioethics Program (M.J.S., S.D.G.), University of Michigan, Ann Arbor, Michigan; National Hospice and Palliative Care Organization (S.R.C.), Alexandria, Virginia, USA; Worldwide Palliative Care Alliance (S.R.C.), London, United Kingdom; and The Children's Hospital of Philadelphia (C.F.), Philadelphia, Pennsylvania, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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