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