TABLE 2.
Determinants of Registration With a Comprehensive Palliative Care Program From Hierarchical Nonlinear Regression, All Cancer Deaths* and by Age
| Determinants | OR (95% CI)
|
|||||
|---|---|---|---|---|---|---|
| All Patients
|
Age <65 Yrs | Ages 65–74 | Ages 75–84 | Ages 85+ | ||
| Unadjusted | Adjusted† | Adjusted† | ||||
| Individual Level | ||||||
| Age (yrs) (vs. <65) | ||||||
| 65–74 | 0.6 (0.5–0.7) | 0.8 (0.7–0.9) | — | — | — | — |
| 75–84 | 0.4 (0.4–0.5) | 0.7 (0.6–0.8) | ||||
| 85+ | 0.2 (0.2–0.2) | 0.4 (0.3–0.5) | ||||
| Environment | ||||||
| Health care system | ||||||
| Distance to cancer centre (vs. >50 km) | ||||||
| 0–10 km | 7.9 (6.6–9.5) | 8.2 (6.0–11.1) | 8.3 (5.3–13.0) | 12.3 (7.8–19.4) | 9.6 (5.9–15.5) | 17.2 (9.1–32.3) |
| 11–50 km | 8.3 (6.9–10.0) | 8.2 (6.1–11.0) | 7.7 (4.9–12.0) | 10.4 (6.5–16.6) | 9.0 (5.5–14.8) | 14.7 (7.8–27.8) |
| Population Characteristics | ||||||
| Predisposing | ||||||
| Sex (vs. female) | ||||||
| Male | 0.8 (0.8–0.9) | 0.8 (0.7–0.9) | 1.0 (0.7–1.3) | 0.7 (0.5–1.0) | 0.7 (0.5–0.9) | 0.7 (0.5–1.0) |
| Survival groups (vs. < 61 days) | ||||||
| 61–120 days | 2.1 (1.7–2.5) | 1.8 (1.5–2.3) | 2.6 (1.6–4.1) | 2.0 (1.3–3.1) | 1.8 (1.2–2.5) | 2.1 (1.3–3.5) |
| 121–183+ days | 1.7 (1.6–2.0) | 1.5 (1.3–1.8) | 2.1 (1.5–3.0) | 2.0 (1.5–2.7) | 1.5 (1.2–1.9) | 1.1 (0.8–1.6) |
| Enabling resources | ||||||
| Long term care resident (vs. no LTC visit) | ||||||
| At least 1 LTC visit | 0.3 (0.3–0.4) | 0.5 (0.4–0.6) | — | 0.5 (0.3–0.9) | 0.6 (0.4–0.8) | 0.3 (0.2–0.4) |
| Need | ||||||
| Cancer cause of death (vs. colorectal) | ||||||
| Breast | 1.1 (0.9–1.4) | 0.6 (0.4–0.7) | 0.6 (0.3–1.3) | 0.5 (0.3–1.0) | 0.6 (0.4–1.1) | 0.4 (0.2–0.8) |
| Lung | 1.0 (0.9–1.2) | 0.8 (0.7–1.0) | 0.6 (0.3–1.0) | 0.7 (0.5–1.1) | 1.1 (0.8–1.7) | 0.9 (0.6–1.5) |
| Gastrointestinal | 1.0 (0.8–1.2) | 1.1 (0.9–1.4) | 0.9 (0.5–1.6) | 1.0 (0.6–1.7) | 1.2 (0.8–1.7) | 1.0 (0.6–1.8) |
| Prostate | 0.5 (0.4–0.7) | 0.6 (0.4–0.8) | 0.3 (0.1–0.8) | 0.7 (0.4–1.4) | 0.7 (0.5–1.1) | 0.4 (0.2–0.8) |
| Genitourinary | 0.7 (0.6–0.9) | 0.8 (0.6–1.0) | 0.7 (0.3–1.5) | 0.8 (0.4–1.4) | 1.0 (0.6–1.6) | 0.6 (0.3–1.2) |
| Gynecologic | 1.2 (0.9–1.6) | 1.0 (0.7–1.5) | 0.7 (0.3–1.4) | 0.6 (0.3–1.4) | 1.4 (0.8–2.4) | 1.4 (0.6–3.4) |
| Hematological | 0.5 (0.4–0.7) | 0.7 (0.5–0.9) | 0.3 (0.2–0.6) | 0.5 (0.3–1.0) | 0.9 (0.6–1.6) | 0.9 (0.5–1.8) |
| Others | 1.1 (0.9–1.4) | 1.2 (0.9–1.6) | 1.1 (0.6–2.2) | 1.1 (0.6–2.1) | 1.3 (0.8–2.2) | 1.0 (0.5–2.0) |
| Unknown primary | 0.6 (0.5–0.7) | 0.6 (0.5–0.8) | 0.7 (0.4–1.3) | 0.8 (0.5–1.4) | 0.6 (0.4–0.9) | 0.6 (0.4–1.0) |
| Comorbidities (Charlson index) | 1.2 (1.2–1.2) | 1.1 (1.1–1.1) | 1.1 (1.1–1.2) | 1.1 (1.0–1.1) | 1.1 (1.1–1.2) | 1.1 (1.1–1.2) |
| Health Behavior | ||||||
| Use of health services | ||||||
| Total hospital inpatient days (vs. 0; also a proxy for need) | ||||||
| 1–14 | 1.4 (1.2–1.6) | 0.8 (0.7–1.0) | 0.8 (0.5–1.2) | 1.1 (0.7–1.6) | 0.8 (0.6–1.1) | 0.7 (0.5–1.1) |
| 15–31 | 1.8 (1.6–2.1) | 1.3 (1.0–1.6) | 1.2 (0.7–1.8) | 1.7 (1.1–2.7) | 1.2 (0.9–1.6) | 0.8 (0.5–1.4) |
| 32 or more | 2.0 (1.7–2.3) | 1.7 (1.4–2.3) | 1.8 (1.2–2.8) | 1.7 (1.1–2.5) | 1.3 (0.9,1.7) | 1.3 (0.8–2.3) |
| All physician visits (vs. <20) | ||||||
| 20–34 | 1.4 (1.3–1.6) | 1.1 (0.9–1.2) | 1.2 (0.9–1.8) | |||
| 35–49 | 1.7 (1.5–2.0) | 1.0 (0.9–1.3) | — | — | — | 1.4 (0.8–2.3) |
| 50+ | 1.6 (1.4–1.8) | 0.7 (0.6–0.9) | 0.7 (0.4–1.2) | |||
| At least 1 chemo-related visit (vs. no) | ||||||
| Yes | 3.7 (3.2–4.3) | 2.0 (1.7–2.5) | 2.2 (1.6–2.9) | 1.6 (1.2–2.3) | 2.1 (1.4–3.0) | 1.7 (0.9–3.1) |
| Radiotherapy received last 6 mo of life (vs. no) | ||||||
| Yes | 3.3 (2.9–3.7) | 2.7 (2.4–3.1) | 2.3 (1.7–3.1) | 2.7 (2.0–3.7) | 2.6 (2.0–3.4) | 3.2 (2.3–4.6) |
| Neighborhood (contextual) Level | ||||||
| Population Characteristics | ||||||
| Predisposing | ||||||
| Visible minorities excluding black (vs. <10%) | ||||||
| ≥10% visible minorities excluding black | 1.6 (1.3–2.0) | 1.3 (1.0–1.7) | — | — | 1.6 (1.1–2.5) | 1.7 (1.0–3.0) |
| Francophone community (vs. <10% French as mother tongue) | ||||||
| ≥10% French as mother tongue | 0.2 (0.1–0.3) | 0.6 (0.3–1.0) | 0.3 (0.1–0.6) | — | 0.4 (0.2–1.0) | — |
| High school graduates (vs. <50% graduated) | ||||||
| ≥50% graduated high school | 2.1 (1.6–2.7) | — | 2.0 (1.1–3.7) | — | — | — |
| Enabling resources | ||||||
| Urban rural indicator (vs. urban) | ||||||
| Rural | 0.5 (0.5–0.6) | 0.8 (0.7–1.0) | — | — | — | — |
| Income quintiles (vs. upper) | ||||||
| Low | 0.8 (0.7–1.0) | 0.9 (0.7–1.1) | — | — | — | — |
| Low-middle | 0.7 (0.6–0.9) | 0.7 (0.6–0.9) | ||||
| Middle | 0.8 (0.7–0.9) | 0.8 (0.6–1.0) | ||||
| Upper-middle | 1.0 (0.8–1.2) | 1.1 (0.8–1.3) | ||||
*
All cancer deaths within the Capital District and Cape Breton District Health Authorities.
†
Final multivariate models. Adjusted for all other factors in the final model. Estimates associated with the population average model with robust standard errors are reported here.