Table 3.
Multivariable logistic regression analyses for end of life (EOL) health service quality indicators with socio-demographics, general health, disease and treatment characteristics of NSCL cancer patients who died from cancer-related causes from January 2009 to December 2017 (N = 37,203).
| Characteristics | Aggressive Care | Supportive Care | ||||
|---|---|---|---|---|---|---|
| Yes | No | Adjusted Stepwise Model | Yes | No | Adjusted Stepwise Model | |
| N = 18,692 (%) | N = 18,499 (%) | Odds Ratio (95% CI) | N = 20,515 (%) | N = 13,507 (%) | Odds Ratio (95% CI) | |
| Socio-demographics | ||||||
| Death year * | ||||||
| Mean ± SD | 2012.56 ± 2.56 | 2012.95 ± 2.54 | 0.96 (0.95–0.97) | 2012.97 ± 2.55 | 2012.53 ± 2.53 | 1.03 (1.02–1.04) |
| Age at death date | ||||||
| 20–49 | 523 (2.80) | 330 (1.78) | Reference | 514 (2.51) | 274 (2.03) | |
| 50–59 | 2392 (12.80) | 1990 (10.76) | 0.69 (0.59–0.81) | 2695 (13.14) | 1382 (10.23) | |
| 60–69 | 5192 (27.78) | 4576 (24.74) | 0.56 (0.48–0.66) | 5656 (27.57) | 3366 (24.92) | |
| 70–79 | 6217 (33.26) | 6114 (33.05) | 0.45 (0.39–0.53) | 6797 (33.13) | 4408 (32.63) | |
| 80+ | 4368 (23.37) | 5489 (29.67) | 0.31 (0.27–0.36) | 4853 (23.66) | 4077 (30.18) | |
| Sex | ||||||
| Female | 8218 (43.97) | 9277 (50.15) | Reference | 9961 (48.55) | 6164 (45.64) | Reference |
| Male | 10,474 (56.03) | 9222 (49.85) | 1.21 (1.16–1.26) | 10,554 (51.45) | 7343 (54.36) | 0.95 (0.91–1.00) |
| Neighborhood income quintile at death date | ||||||
| 1 Lowest | 4747 (25.40) | 4528 (24.48) | 4820 (23.50) | 3645 (26.99) | Reference | |
| 2 | 4227 (22.61) | 4079 (22.05) | 4583 (22.34) | 3007 (22.26) | 1.13 (1.06–1.22) | |
| 3 | 3658 (19.57) | 3623 (19.58) | 4105 (20.01) | 2580 (19.10) | 1.15 (1.07–1.23) | |
| 4 | 3214 (17.19) | 3268 (17.67) | 3673 (17.90) | 2246 (16.63) | 1.19 (1.11–1.29) | |
| 5 Highest | 2781 (14.88) | 2945 (15.92) | 3284 (16.01) | 1973 (14.61) | 1.18 (1.09–1.27) | |
| Place of residence at death date | ||||||
| Erie St. Clair | 1012 (5.41) | 1316 (7.11) | 0.60 (0.53–0.69) | 1469 (7.16) | 732 (5.42) | 2.09 (1.81–2.41) |
| South West | 1660 (8.88) | 1360 (7.35) | 0.97 (0.86–1.09) | 1605 (7.82) | 1124 (8.32) | 1.41 (1.24–1.61) |
| Waterloo Wellington | 784 (4.19) | 1128 (6.10) | 0.71 (0.62–0.80) | 1372 (6.69) | 465 (3.44) | 2.86 (2.47–3.32) |
| Hamilton Niagara Halimand Brant | 2105 (11.26) | 2797 (15.12) | 0.68 (0.61–0.76) | 2870 (13.99) | 1698 (12.57) | 1.92 (1.71–2.15) |
| Central West | 824 (4.41) | 532 (2.88) | 1.57 (1.36–1.80) | 697 (3.40) | 492 (3.64) | 1.35 (1.15–1.58) |
| Mississauga Halton | 1045 (5.59) | 1036 (5.60) | 1.15 (1.01–1.29) | 1213 (5.91) | 675 (5.00) | 1.68 (1.46–1.93) |
| Toronto Central | 1210 (6.47) | 1337 (7.23) | Reference | 1251 (6.10) | 1040 (7.70) | Reference |
| Central | 1591 (8.51) | 1660 (8.97) | 1.09 (0.98–1.22) | 1577 (7.69) | 1325 (9.81) | 0.87 (0.77–0.98) |
| Central East | 2709 (14.49) | 1854 (10.02) | 1.46 (1.31–1.62) | 2326 (11.34) | 1778 (13.16) | 1.11 (0.99–1.25) |
| South East | 1143 (6.11) | 1075 (5.81) | 0.82 (0.72–0.94) | 980 (4.78) | 1074 (7.95) | 0.88 (0.77–1.01) |
| Champlain | 1714 (9.17) | 2047 (11.07) | 0.70 (0.63–0.78) | 2237 (10.90) | 1268 (9.39) | 1.78 (1.57–2.01) |
| North Simcoe Muskoka | 830 (4.44) | 839 (4.54) | 0.73 (0.64–0.84) | 1036 (5.05) | 535 (3.96) | 2.13 (1.82–2.48) |
| North East | 1599 (8.55) | 1107 (5.98) | 1.02 (0.90–1.15) | 1539 (7.50) | 879 (6.51) | 1.99 (1.73–2.28) |
| North West | 466 (2.49) | 411 (2.22) | 0.91 (0.76–1.08) | 343 (1.67) | 422 (3.12) | 0.66 (0.55–0.80) |
| Rurality status at death date | ||||||
| Yes | 3524 (18.85) | 2322 (12.55) | 1.09 (1.00–1.20) | 3089 (15.06) | 2166 (16.04) | 0.94 (0.88–1.00) |
| Type of environment at death date | ||||||
| Urban (RIO < 10) | 10,737 (57.44) | 12,209 (66.00) | 0.59 (0.53–0.66) | 12,620 (61.52) | 8397 (62.17) | 0.82 (0.75–0.89) |
| Suburban (10 ≤ RIO < 40) |
4990 (26.70) | 4536 (24.52) | 0.73 (0.66–0.81) | 5434 (26.49) | 3373 (24.97) | 1.00 (0.92–1.10) |
| Rural (40 ≤ RIO) | 2711 (14.50) | 1580 (8.54) | Reference | 2250 (10.97) | 1563 (11.57) | Reference |
| General health characteristics | ||||||
| Chronic comorbidities prior to death | ||||||
| Asthma | 3283 (17.56) | 3156 (17.06) | 3464 (16.89) | 2399 (17.76) | ||
| Chronic obstructive pulmonary disease |
11,397 (60.97) | 10,743 (58.07) | 1.05 (1.00–1.10) | 11,889 (57.95) | 8326 (61.64) | 0.96 (0.91–1.01) |
| Congestive heart failure |
3643 (19.49) | 2984 (16.13) | 1.12 (1.05–1.19) | 3084 (15.03) | 2795 (20.69) | 0.88 (0.82–0.94) |
| Elixhauser comorbidity index ** | ||||||
| 0–1 | 8389 (44.88) | 9982 (53.96) | Reference | 11,086 (54.04) | 6106 (45.21) | Reference |
| 2–3 | 6371 (34.08) | 5478 (29.61) | 1.46 (1.39–1.54) | 6149 (29.97) | 4547 (33.66) | 0.76 (0.72–0.81) |
| 4+ | 3932 (21.04) | 3039 (16.43) | 1.66 (1.55–1.77) | 3280 (15.99) | 2854 (21.13) | 0.68 (0.64–0.74) |
| Disease and treatment characteristics | ||||||
| Number of months from first cancer diagnosis to death | ||||||
| 0–<1 | 4100 (21.93) | 1592 (8.61) | Reference | 1233 (6.01) | 3618 (26.79) | Reference |
| 1–<2 | 2216 (11.86) | 2164 (11.70) | 0.41 (0.37–0.45) | 1988 (9.69) | 1824 (13.50) | 2.59 (2.35–2.85) |
| 2–<3 | 1512 (8.09) | 1731 (9.36) | 0.39 (0.35–0.42) | 1878 (9.15) | 1068 (7.91) | 3.69 (3.31–4.10) |
| 3–<6 | 2617 (14.00) | 3150 (17.03) | 0.38 (0.35–0.42) | 3754 (18.30) | 1638 (12.13) | 4.37 (3.97–4.81) |
| 6–<12 | 2700 (14.44) | 3153 (17.04) | 0.39 (0.36–0.43) | 3977 (19.39) | 1556 (11.52) | 4.75 (4.31–5.23) |
| 12+ | 5547 (29.68) | 6709 (36.27) | 0.37 (0.35–0.41) | 7685 (37.46) | 3803 (28.16) | 4.04 (3.71–4.41) |
| Prior adjuvant systemic therapy for thoracic tumour resection or curative concurrent chemoradiation | ||||||
| Prior to death date | 1463 (7.83) | 1382 (7.47) | 1.18 (1.08–1.28) | 1752 (8.54) | 905 (6.70) | 0.83 (0.76–0.92) |
| Palliative intent systemic therapy, radiotherapy and metastasis surgery | ||||||
| Prior to death date | 8962 (47.95) | 10,700 (57.84) | 0.87 (0.83–0.92) | 13,139 (64.05) | 5551 (41.10) | 1.49 (1.41–1.57) |
| Number of days from first access to palliative care consultation *** to death | ||||||
| >180 | 983 (5.26) | 1719 (9.29) | 0.56 (0.51–0.62) | 2165 (10.55) | 467 (3.46) | 3.46 (3.09–3.88) |
| 61–180 | 1334 (7.14) | 2665 (14.41) | 0.49 (0.46–0.53) | 3189 (15.54) | 674 (4.99) | 3.41 (3.10–3.76) |
| 31–60 | 1024 (5.48) | 1906 (10.30) | 0.53 (0.49–0.58) | 2121 (10.34) | 625 (4.63) | 2.75 (2.49–3.04) |
| ≤30 | 3764 (20.14) | 2959 (16.00) | 1.06 (0.99–1.12) | 3454 (16.84) | 2510 (18.58) | 1.55 (1.45–1.66) |
| None | 11,587 (61.99) | 9250 (50.00) | Reference | 9586 (46.73) | 9231 (68.34) | Reference |
CI, Confidence Interval; RIO, Rurality Index for Ontario; * Odds ratio measured as per 1-year increase; ** Five-year lookback from death: Total comorbidity score excludes indices for metastatic cancer and solid tumour without metastases; *** OHIP billing codes: A945, C945; Notes: Aggressive and supportive care outcomes were both composite scores for occurrence of any one or more the respective indicators; In the adjusted stepwise model, variables with a significance level of 0.20 were used for model selection and variables with a significance level of 0.10 remained in the final model. The stepwise model selection approach excluded variables that do not significantly contribute to the final model; Missing values for the outcomes and variables were first excluded before running the logistic regression analyses. Significant associations discussed in the text are bolded.