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. Author manuscript; available in PMC: 2020 Jul 7.
Published in final edited form as: J Pain Symptom Manage. 2019 Nov 26;59(4):767–777.e1. doi: 10.1016/j.jpainsymman.2019.11.015

Table 4.

Adjusted RR of Medication Receipt by Symptom Category Among Medicare Beneficiaries With Advanced Lung Cancer at EOL-1

Any Dyspnea Medication Any Pain Medication Any Emotional Distress Medication
Decedent Characteristic RR P 95% CI RR P 95% CI RR P 95% CI
Sex (reference = male)
 Female 1.10 0.019 1.02–1.18 1.32 <0.001 1.23–1.42 1.35 <0.001 1.27–1.45
Age category (reference = 66–69)
 70–74 1.05 0.443 0.93–1.18 0.82 0.001 0.73–0.92 0.88 0.012 0.79–0.97
 75–79 0.95 0.424 0.85–1.07 0.68 <0.001 0.60–0.76 0.74 <0.001 0.67–0.83
 80+ 0.86 0.011 0.77–0.97 0.45 <0.001 0.41–0.51 0.68 <0.001 0.61–0.75
Race/ethnicity (reference = white, non-Hispanic)
 Black, non-Hispanic 0.80 0.002 0.70–0.92 0.79 0.001 0.69–0.91 0.57 <0.001 0.50–0.64
 Hispanic 0.73 <0.001 0.62–0.85 0.74 <0.001 0.63–0.87 0.62 <0.001 0.53–0.72
 Asian, other 0.73 <0.001 0.63–0.85 0.57 <0.001 0.49–0.65 0.51 <0.001 0.44–0.59
Marital status (reference = married)
 Unmarried 0.92 0.051 0.85–1.00 0.98 0.558 0.91–1.05 0.92 0.026 0.86–0.99
Poverty rates (census tract level) (reference = low)
 5%-<10% 1.04 0.439 0.94–1.16 1.10 0.051 1.00–1.22 0.94 0.228 0.86–1.04
 10%-<20% 1.03 0.643 0.92–1.14 1.10 0.055 1.00–1.21 0.86 0.003 0.78–0.95
 High (20%−100%) 0.94 0.322 0.83–1.06 1.21 0.001 1.08–1.35 0.80 <0.001 0.72–0.90
Lung cancer histology (reference = SCLC)
 NSCLC 1.08 0.111 0.98–1.18 0.95 0.265 0.87–1.04 0.94 0.150 0.87–1.02
Dual Medicaid enrolled (reference = no)
 Yes 1.24 <0.001 1.13–1.36 1.46 <0.001 1.34–1.58 1.23 <0.001 1.14–1.33
Elixhauser Comorbidity Index (reference = 0)
 One to two conditions 1.61 <0.001 1.48–1.76 1.10 0.031 1.01–1.19 1.24 <0.001 1.15–1.34
 Three or more conditions 2.10 <0.001 1.90–2.32 1.15 0.004 1.05–1.26 1.51 <0.001 1.38–1.65
Current cancer-directed therapy (at EOL-1) (reference for each = no)
 Chemotherapy 1.11 0.064 0.99–1.24 0.97 0.533 0.87–1.07 1.35 <0.001 1.23–1.49
 Radiation 1.47 <0.001 1.20–1.81 1.32 0.006 1.08–1.61 0.94 0.503 0.79–1.12
Treatment modality initiated before EOL observation period (reference for each = no)
 First-line systemic therapy 1.14 0.002 1.05–1.23 1.11 0.009 1.03–1.19 0.93 0.038 0.86–1.00
 Surgical resection 1.06 0.263 0.96–1.17 1.03 0.545 0.94–1.13 1.15 0.003 1.05–1.26
 Radiation 1.05 0.363 0.95–1.16 1.30 <0.001 1.17–1.44 1.01 0.843 0.92–1.11
MSA (reference = large MSA)
 Urban 0.91 0.196 0.79–1.05 1.16 0.041 1.01–1.35 0.96 0.522 0.84–1.09
 Less urban/rural/unknown 1.07 0.212 0.96–1.20 1.22 0.000 1.09–1.36 1.02 0.675 0.92–1.13
Any Anorexia Medication Any Fatigue Medication Medication Nausea/Vomiting
RR P 95% CI RR P 95% CI RR P 95% CI
Sex (reference = male)
 Female 0.85 <0.001 0.79–0.92 0.89 0.007 0.82–0.97 1.27 <0.001 1.17–1.38
Age category (reference = 66–69)
 70–74 0.99 0.901 0.88–1.12 0.92 0.195 0.82–1.04 0.88 0.040 0.78–0.99
 75–79 1.09 0.187 0.96–1.23 0.78 <0.001 0.69–0.89 0.78 <0.001 0.68–0.88
 80+ 1.02 0.698 0.91–1.15 0.68 <0.001 0.60–0.77 0.57 <0.001 0.50–0.65
Race/ethnicity (reference = white, non-Hispanic)
 Black, non-Hispanic 1.49 <0.001 1.32–1.69 1.48 <0.001 1.28–1.72 0.76 0.001 0.64–0.89
 Hispanic 1.13 0.151 0.96–1.33 1.43 <0.001 1.20–1.71 1.01 0.883 0.84–1.22
 Asian, other 1.90 <0.001 1.66–2.19 1.38 <0.001 1.16–1.63 0.75 0.002 0.62–0.90
Marital status (reference = married)
 Unmarried 0.84 <0.001 0.78–0.91 0.96 0.376 0.88–1.05 0.90 0.021 0.83–0.98
Poverty rates (census tract level) (reference = low)
 5%-<10% 0.99 0.931 0.88–1.12 0.92 0.145 0.81–1.03 0.98 0.752 0.87–1.11
 10%-<20% 1.16 0.010 1.04–1.30 0.86 0.015 0.77–0.97 1.04 0.547 0.92–1.17
 High (20%−100%) 1.32 <0.001 1.17–1.49 0.89 0.078 0.78–1.01 0.99 0.929 0.87–1.14
Lung cancer histology (reference = SCLC)
 NSCLC 1.05 0.288 0.96–1.15 1.05 0.350 0.95–1.16 0.87 0.004 0.79–0.96
Dual Medicaid enrolled (reference = no)
 Yes 1.27 <0.001 1.17–1.38 0.98 0.655 0.89–1.08 1.12 0.018 1.02–1.24
Elixhauser Comorbidity Index (reference = 0)
 One to two conditions 0.99 0.787 0.90–1.08 0.98 0.697 0.89–1.08 1.00 0.939 0.91–1.11
 Three or more conditions 0.86 0.003 0.77–0.95 1.41 <0.001 1.26–1.56 0.93 0.222 0.84–1.04
Current cancer-directed therapy (at EOL-1) (reference = no)
 Chemotherapy 1.83 <0.001 1.64–2.05 2.82 0.000 2.55–3.12 N/A N/A N/A
 Radiation 1.31 0.011 1.06–1.60 0.95 0.643 0.77–1.17 1.40 0.001 1.14–1.71
Treatment modality initiated before EOL observation period (reference = no)
 First-line systemic therapy 1.12 0.006 1.03–1.21 0.90 0.020 0.83–0.98 0.87 0.001 0.80–0.95
 Surgical resection 1.09 0.111 0.98–1.21 1.06 0.349 0.94–1.18 1.26 <0.001 1.13–1.40
 Radiation 1.34 <0.001 1.21–1.49 1.13 0.030 1.01–1.26 1.02 0.694 0.91–1.15
MSA (reference = Large MSA)
 Urban 0.89 0.141 0.76–1.04 0.80 0.009 0.67–0.95 1.13 0.134 0.96–1.33
 Less urban/rural/unknown 1.14 0.018 1.02–1.27 0.91 0.145 0.80–1.03 1.22 0.001 1.08–1.37

RR = relative risk; EOL = end of life; SCLC = small cell lung cancer; NSCLC = non-small cell lung cancer; MSA = metropolitan statistical area; N/A = not available.