Table 2.
Estimates of Effects of Local Area Hospice Capacity and Rural/Urban Residence on Hospice Use among Older Adults with Metastatic Breast Cancer
| Variable | N | Model 1a | Model 1+driving time | Model 1+driving time No. of hospice practices | Model 1+driving time No. of hospice employees |
|---|---|---|---|---|---|
| Rural/urban area characteristics | 5418 | ||||
| p Value of F-statistics | 0.0090* | 0.02* | 0.0153* | 0.1044 | |
| OR (95% CI) | |||||
| Metro ≥1M | 3037 | Reference | Reference | Reference | Reference |
| Metro 250K–1M | 1000 | 0.971 (0.809–1.165) | 0.978 (0.815–1.174) | 0.979 (0.816–1.175) | 1.017 (0.846–1.223) |
| Metro ≤250K pop. | 532 | 0.965 (0.771–1.208) | 0.966 (0.771–1.210) | 0.967 (0.772–1.212) | 1.049 (0.831–1.323) |
| Urban, adjacent to metro >20K | 203 | 0.692 (0.500–0.958) | 0.708 (0.510–0.982) | 0.717 (0.516–0.995) | 0.756 (0.543–1.052) |
| Urban, not adjacent to metro >20K | 108 | 0.766 (0.482–1.218) | 0.747 (0.465–1.200) | 0.751 (0.468–1.207) | 0.877 (0.538–1.429) |
| Urban, adjacent to metro <20K | 269 | 0.809 (0.597–1.096) | 0.832 (0.612–1.130) | 0.823 (0.605–1.119) | 0.903 (0.661–1.234) |
| Urban, not adjacent to metro <20K | 190 | 0.519 (0.363–0.741) | 0.537 (0.375–0.770) | 0.520 (0.360–0.751) | 0.612 (0.422–0.888) |
| Rural, adjacent to metro <2500 | 42 | 0.865 (0.445–1.679) | 0.929 (0.472–1.827) | 0.905 (0.459–1.785) | 0.989 (0.503–1.947) |
| Rural, not adjacent to metro <2500 | 37 | 0.457 (0.224–0.930) | 0.470 (0.230–0.962) | 0.454 (0.221–0.932) | 0.545 (0.265–1.123) |
| Driving time | |||||
| p Value of χ2-statistics | 0.2892 | 0.3501 | 0.3792 | ||
| Parameter estimate | −0.00136 | −0.00117 | −0.00108 | ||
| OR (95% CI) | 0.999 (0.996–1.001) | 0.999 (0.996–1.001) | 0.999 (0.997–1.001) | ||
| Per capita number of hospices | |||||
| p Value of χ2-statistics | 0.3810 | ||||
| Parameter estimate | 0.0203 | ||||
| OR (95% CI) | 1.021 (0.975–1.068) | ||||
| Per capita number of hospice employees | |||||
| p Value of χ2-statistics | 0.0042* | ||||
| Parameter estimate | 0.0239 | ||||
| OR (95% CI) | 1.024 (1.008–1.041) |
Results were tabulated based on the local area defined as a 70-minute driving time radius. Driving time, rural/urban area characteristics, per capita number of Medicare-certified hospice programs, and per capita number of hospice employees were defined the same as in the Materials and Methods section.
Control variables in the model include patient age, race, comorbidities, marital status, census tract median household income and education level, residence SEER area, and diagnosis year.
Model 1 includes rural/urban characteristics plus control variables.
Significance level at 0.05 level.
CI, confidence interval; OR, odds ratio; SEER, Surveillance Epidemiology End-Results.