Table 2.
Demographic-, clinical-, and hospital-related predictors of hospice utilization and late hospice enrollment (length of stay <7 days vs ≥7 days before death) among patients with brain metastases
| Variable | Multivariable OR for hospice enrollment (95% CI) | P ¶ | Multivariable OR for late hospice enrollment* (95% CI) | P ¶ |
|---|---|---|---|---|
| Age quintiles, y | ||||
| 66–69 | 1.00 (Referent) | 1.00 (Referent) | ||
| 70–72 | 1.02 (0.96 to 1.09) | .49 | 1.03 (0.95 to 1.10) | .50 |
| 73–76 | 1.04 (0.98 to 1.10) | .24 | 0.93 (0.87 to 1.00) | .04 |
| 77–81 | 1.00 (0.94 to 1.06) | .94 | 0.97 (0.91 to 1.04) | .44 |
| 82–104 | 1.19 (1.12 to 1.27) | <.001 | 0.90 (0.83 to 0.96) | .003 |
| Sex | ||||
| Female | 1.00 (Referent) | 1.00 (Referent) | ||
| Male | 0.78 (0.74 to 0.81) | <.001 | 1.36 (1.29 to 1.43) | <.001 |
| Race/Ethnicity | ||||
| White | 1.00 (Referent) | 1.00 (Referent) | ||
| Black | 0.76 (0.71 to 0.82) | <.001 | 0.97 (0.89 to 1.06) | .54 |
| Hispanic | 0.80 (0.72 to 0.87) | <.001 | 0.85 (0.76 to 0.96) | .007 |
| Asian | 0.52 (0.48 to 0.57) | <.001 | 0.82 (0.72 to 0.93) | .002 |
| Other or unknown | 0.87 (0.63 to 1.18) | .36 | 1.19 (0.83 to 1.70) | .35 |
| Marital status | ||||
| Single | 1.00 (Referent) | 1.00 (Referent) | ||
| Married | 1.03 (0.99 to 1.07) | .19 | 1.06 (1.01 to 1.11) | .03 |
| Unknown | 1.09 (0.99 to 1.21) | .08 | 1.14 (1.02 to 1.26) | .02 |
| Residence | ||||
| Rural | 1.00 (Referent) | 1.00 (Referent) | ||
| Urban | 1.10 (1.02 to 1.18) | .02 | 1.11 (1.02 to 1.21) | .02 |
| Unknown | 0.86 (0.78 to 1.06) | .19 | 0.92 (0.81 to 1.03) | .14 |
| Zip-code level household income, per US $10 000 increase† | 0.98 (0.97 to 0.99) | <.001 | 1.01 (1.00 to 1.02) | .22 |
| Zip-code level high school graduates, per percent increase† | 1.01 (1.01 to 1.01) | <.001 | 1.00 (1.00 to 1.00) | .67 |
| Primary cancer site‡ | ||||
| Lung cancer | 1.00 (Referent)§ | 1.00 (Referent)§ | ||
| Breast cancer | 1.04 (0.97 to 1.12) | .25 | 1.05 (0.98 to 1.14) | .19 |
| Melanoma | 1.24 (1.14 to 1.35) | <.001 | 1.05 (0.96 to 1.15) | .26 |
| Renal cancer | 0.99 (0.89 to 1.10) | .83 | 0.89 (0.79 to 1.01) | .06 |
| Colorectal cancer | 1.07 (0.98 to 1.17) | .13 | 0.84 (0.76 to 0.93) | .001 |
| Ovarian cancer | 1.44 (1.13 to 1.82) | .003 | 0.90 (0.71 to 1.14) | .39 |
| Esophageal cancer | 1.26 (1.04 to 1.51) | .02 | 1.00 (0.82 to 1.22) | 1.00 |
| Other | 1.04 (0.97 to 1.12) | .28 | 1.04 (0.96 to 1.14) | .33 |
| Charlson Comorbidity Index | ||||
| 0–2 | 1.00 (Referent) | 1.00 (Referent) | ||
| ≥3 | 0.90 (0.84 to 0.96) | .001 | 1.23 (1.14 to 1.32) | <.001 |
| Unknown | 0.95 (0.90 to 1.00) | .07 | 0.95 (0.89 to 1.01) | .08 |
| Received care at a medical school–affiliated hospital‖ | ||||
| No | 1.00 (Referent) | 1.00 (Referent) | ||
| Yes | 1.02 (0.98 to 1.07) | .28 | 0.94 (0.89 to 0.98) | .009 |
| Received care at an urban hospital‖ | ||||
| No | 1.00 (Referent) | 1.00 (Referent) | ||
| Yes | 0.99 (0.92 to 1.06) | .73 | 1.07 (0.99 to 1.16) | .11 |
| Unknown | 0.91 (0.84 to 1.06) | .23 | 0.96 (0.87 to 1.07) | .47 |
| Received care at a government hospital‖ | ||||
| No | 1.00 (Referent) | 1.00 (Referent) | ||
| Yes | 1.07 (1.03 to 1.12) | .002 | 0.93 (0.89 to 0.98) | .007 |
*
Among patients enrolled in hospice. CI = confidence interval; OR = odds ratio.
†
Median household income and high school graduates were obtained by linking patient zip codes to information from the 2000 US Census and the 2008–2012 America Community Survey.
‡
First cancer type was used for patients with multiple primary tumors.
§
Lung cancer was used as the reference group because of the highest prevalence in the study cohort.
‖
Within 1 year of date of death.
¶
Multivariable regression analysis was used. P values are 2-sided.