Terminally ill patients with a low median annual household income are less likely to die at home than their wealthier counterparts, according to US study results published in JAMA Internal Medicine.
The findings even held true for those with limited socioeconomic resources who had the support of routine hospice care, indicating a need for hospices to provide additional resources to help indigent patients die at home, suggest the authors.
"Even short periods of more intense support, such as that provided by a higher level of care (continuous care), may help overcome socioeconomic resource disparities and allow patients to die at home when consistent with their preferences," say Joshua Barclay (University of Virginia, Charlottesville) and colleagues.
Patients who remained at home before death were more likely to have received continuous care - defined as a higher level of care used for short periods of crisis to keep a patient at home - than those who were transferred elsewhere before death.
Furthermore, those who were transferred were more likely to be in the lower income categories (less than US$ 40,000 [€ 30,350]) than those who remained at home.
The study population included 61,063 terminally ill hospice enrollees who died between January 1999 and December 2003, of whom 22.6% were transferred from home before their deaths. The median annual household income for patients was $ 42,573 (€ 32,303), which was akin to the average US income for 2000.
The absolute difference in probability of dying at home was 0.17 between patients who were in the lowest income category ($ 0-20,000 [€ 15,175]) and those in the highest (>$ 50,000 [€ 37,940]), report Barclay et al. The association between income and transfer from home before death persisted after accounting for confounders, but only among patients who did not receive continuous care.
In an accompanying commentary, Ebun Abarshi (Lancaster University, UK), remarks: "The next frontier in palliative care service is the development of specialist teams that function through palliative care clinics, day care centers, outpatient clinics, hospital wards, and intensive care units. These teams would offer a unique approach to improving end-of-life care for outpatients who may not be well served by existing structures of care and cannot enroll in hospices."
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