Table 3. Factors associated with use of the Medicare SNF benefit in the last 6 months of life.
| Unadjusted RR (95% CI) | P Value | Adjusted RR (95% CI)* | P Value | |
|---|---|---|---|---|
|
| ||||
| Demographic Factors | ||||
| Age at death | ||||
| < 85 | ref | ref | ||
| ≥ 85 | 1.42 (1.31-1.53) | <0.001 | 1.34 (1.20-1.49) | <0.001 |
|
| ||||
| Men | ref | ref | ||
| Women | 1.14 (1.04-1.25) | 0.005 | 1.01 (0.90-1.13) | 0.86 |
|
| ||||
| Race/Ethnicity | ||||
| Non-Hispanic White | ref | ref | ||
| Non-Hispanic Black | 0.87 (0.74-1.03) | 0.10 | 0.86 (0.71-1.03) | 0.10 |
| Hispanic | 0.78 (0.59-1.05) | 0.10 | 0.81 (0.59-1.09) | 0.16 |
| Other | 0.67 (0.41-1.09) | 0.10 | 0.67 (0.41-1.10) | 0.11 |
|
| ||||
| Social Factors | ||||
| Marital Status | ||||
| Married/Partnered | ref | ref | ||
| Not Married/Partnered | 1.22 (1.10-1.36) | <0.001 | 1.06 (0.94-1.20) | 0.33 |
|
| ||||
| Educational attainment | ||||
| < High school | 0.95 (0.88-1.02) | 0.15 | 0.89 (0.82-0.98) | 0.01 |
| ≥ High school | ref | ref | ||
|
| ||||
| Household Net Worth | ||||
| Quartile 1 (lowest) | 1.19 (1.05-1.35) | 0.008 | 1.15 (0.99-1.32) | 0.06 |
| Quartile 2 | 1.08 (0.94-1.22) | 0.27 | 1.10 (0.96-1.27) | 0.17 |
| Quartile 3 | 0.98 (0.85-1.13) | 0.78 | 0.99 (0.86-1.15) | 0.91 |
| Quartile 4 | ref | ref | ||
|
| ||||
| Region of Death | ||||
| Midwest | ref | ref | ||
| South | 0.92 (0.81-1.05) | 0.21 | 0.97 (0.85-1.09) | 0.58 |
| Northeast | 1.08 (0.93-1.26) | 0.33 | 1.09 (0.95-1.26) | 0.21 |
| West | 1.05 (0.87-1.28) | 0.60 | 1.03 (0.83-1.29) | 0.77 |
|
| ||||
| ADL dependence prior to last 6 months of life | ||||
| Yes | 1.19 (1.09-1.31) | <0.001 | 1.06 (0.95-1.18) | 0.30 |
| No | ref | ref | ||
|
| ||||
| Nursing home resident prior to last 6 months of life | ||||
| Yes | 1.45 (1.29-1.63) | <0.001 | 1.23 (1.06-1.42) | 0.006 |
| No | ref | ref | ||
|
| ||||
| Used home health services prior to last 6 months of life† | ||||
| Yes | 1.34 (1.20-1.50) | <0.001 | 1.24 (1.09-1.40) | 0.002 |
| No | ref | ref | ||
|
| ||||
| Clinical Factors | ||||
| Chronic Conditions | ||||
| Cancer | 0.86 (0.77-0.96) | 0.009 | 0.89 (0.80-0.99) | 0.04 |
| No Cancer | ref | ref | ||
| Hypertension | 1.04 (0.93-1.15) | 0.50 | 1.03 (0.93-1.13) | 0.61 |
| No Hypertension | ref | ref | ||
| Diabetes | 1.03 (0.91-1.17) | 0.60 | 1.11 (0.98-1.26) | 0.09 |
| No Diabetes | ref | ref | ||
| Lung Disease | 0.97 (0.87-1.09) | 0.64 | 1.02 (0.90-1.14) | 0.79 |
| No Lung Disease | ref | ref | ||
| Heart Disease | 1.05 (0.96-1.14) | 0.30 | 1.02 (0.93-1.12) | 0.61 |
| No Heart Disease | ref | ref | ||
| Stroke | 1.08 (0.94-1.24) | 0.25 | 0.99 (0.85-1.14) | 0.84 |
| No Stroke | ref | ref | ||
| Cognitive Impairment | 1.16 (1.06-1.28) | 0.002 | 1.04 (0.93-1.16) | 0.50 |
| No Cognitive Impairment | ref | ref | ||
|
| ||||
| Death Expected | ||||
| Yes | 1.50 (1.36-1.66) | <0.001 | 1.46 (1.30-1.63) | <0.001 |
| No | ref | ref | ||
*
Adjusted for age, gender, race/ethnicity, marital status, educational attainment, household net worth, region of death, history of ADL dependence, and presence or absence of chronic conditions.
†
Analysis only done on community dwelling residents