• Chih-Yuan Huang, Yeh-Ting Hung, Chun-Ming Chang, Shiun-Yang Juang, and Ching-Chih Lee.
• Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.2, Ming-Sheng Road, Dalin Town, Chiayi, 622, Taiwan (ROC).
• Plos One. 2015 Jan 1;10(1):e0116913.

ObjectivesTo examine the association of individual income and end of life (EOL) care in older cancer decedents in Taiwan.DesignRetrospective cohort study.SettingNational Health Insurance Research Database (NHIRD) in Taiwan.Participants28,978 decedents >65 years were diagnosed with cancer and died during 2009-2011 in Taiwan. Of these decedents, 10941, 16535, and 1502 were categorized by individual income as having low, moderate, and high SES, respectively.Main Outcome MeasuresIndicators of aggressiveness of EOL care: chemotherapy use before EOL, more than one emergency department (ER) visit, more than one hospital admission, hospital length of stay >14 days, intensive care unit (ICU) admission, and dying in a hospital.ResultsLow individual income was associated with more aggressive EOL treatment (estimate -0.30 for moderate income, -0.27 for high income, both p<0.01). The major source of aggressiveness was the tendency for older decedents with low income to die in the acute care hospital. The indicators had an increasing trend from 2009 to 2011, except for hospital stay >14 days.ConclusionsLow individual income is associated with more aggressive EOL treatment in older cancer decedents. Public health providers should make available appropriate education and hospice resources to these decedents and their families, to reduce the amount of aggressive terminal care such decedents receive.

28 keywords...

hide…