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Abstract: FR-PO838

Regional Factors Associated with Hospice Use in the US Hemodialysis Population

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Cruz Whitley, Jessica, UC Davis, Sacramento, California, United States
  • Bang, Heejung, UC-Davis, Davis, California, United States
  • Chin, Andrew I., University of California Davis, Sacramento, California, United States
Background

Hospice use remains underutilized in the US ESRD population. We explored patient, hospice, and community factors at the county level for hospice use in a contemporary cohort of hemodialysis (HD) patients.

Methods

All deaths in patients on HD from 2014-2015 in the USRDS database were obtained. Hospice use was based on the death form hospice indicator or at least one Medicare hospice charge the year of death. Number of Medicare-certified hospices, their profit status, and regional characteristics at the County level were obtained from publically available databases and linked to the patient by County. Univariate comparisons and Multivariables Logistic Regression models were used.

Results

Of 140,729 deceased patients, 25% utilized hospice at the time of death. Those who utilized hospice were older at the time of death, predominantly White (74%), and non-Hispanic (89%). In logistic regression analyses, men were 11% less likely to utilize hospice than women, Hispanics were 12% less likely to use hospice than non-Hispanics, and Blacks were 33% less likely to utilize hospice than Whites. Those who utilized hospice were 3% more likely to have a Medicare certified hospice within their county. The number of hospices within county of residence and non-profit status were positively associated with hospice use. Residing in the Northeast region of the US and higher % of Medicare recipients eligible for Medicaid in the county were negatively associated with hospice use. Other socio-economic factors and intensity of care measures did not appear to be associated with hospice use.

Conclusion

Patient demographics associated with hospice use are consistent with published research. We also found that the region in the US, number of hospices in the county of residence and the composition of Medicare recipients in the county appear to also be associated with hospice use in a contemporary HD cohort.

Characteristics of patients by hospice status at time of death
CharacteristicsNo hospice
N = 105, 375 (75%)
Hospice
N = 35,354 (25%)
Mean age at death, years (SD)67 (13)73 (12)
Male57%55%
White
Black
63%
32%
74%
22%
Hispanic12%11%
Region *
NW
NE
S
W
--
73%
78%
75%
73%
--
27%
22%
25%
27%

All p-values <0.0001. * row % within each region; all others are column %.