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Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer.

Publication ,  Journal Article
Karanth, S; Osazuwa-Peters, OL; Wilson, LE; Previs, RA; Rahman, F; Huang, B; Pisu, M; Liang, M; Ward, KC; Schymura, MJ; Berchuck, A; Akinyemiju, TF
Published in: Cancer Res Commun
March 18, 2024

UNLABELLED: This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results-linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83-0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84-0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03-1.30), no hospice care (aRR 1.23, 95% CI: 1.04-1.44), in-hospital death (aRR 1.27, 95% CI: 1.03-1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04-1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. SIGNIFICANCE: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.

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Published In

Cancer Res Commun

DOI

EISSN

2767-9764

Publication Date

March 18, 2024

Volume

4

Issue

3

Start / End Page

811 / 821

Location

United States

Related Subject Headings

  • White
  • United States
  • Terminal Care
  • Retrospective Studies
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Hospital Mortality
  • Health Services Accessibility
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Karanth, S., Osazuwa-Peters, O. L., Wilson, L. E., Previs, R. A., Rahman, F., Huang, B., … Akinyemiju, T. F. (2024). Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer. Cancer Res Commun, 4(3), 811–821. https://doi.org/10.1158/2767-9764.CRC-23-0283
Karanth, Shama, Oyomoare L. Osazuwa-Peters, Lauren E. Wilson, Rebecca A. Previs, Fariha Rahman, Bin Huang, Maria Pisu, et al. “Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer.Cancer Res Commun 4, no. 3 (March 18, 2024): 811–21. https://doi.org/10.1158/2767-9764.CRC-23-0283.
Karanth S, Osazuwa-Peters OL, Wilson LE, Previs RA, Rahman F, Huang B, et al. Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer. Cancer Res Commun. 2024 Mar 18;4(3):811–21.
Karanth, Shama, et al. “Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer.Cancer Res Commun, vol. 4, no. 3, Mar. 2024, pp. 811–21. Pubmed, doi:10.1158/2767-9764.CRC-23-0283.
Karanth S, Osazuwa-Peters OL, Wilson LE, Previs RA, Rahman F, Huang B, Pisu M, Liang M, Ward KC, Schymura MJ, Berchuck A, Akinyemiju TF. Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer. Cancer Res Commun. 2024 Mar 18;4(3):811–821.

Published In

Cancer Res Commun

DOI

EISSN

2767-9764

Publication Date

March 18, 2024

Volume

4

Issue

3

Start / End Page

811 / 821

Location

United States

Related Subject Headings

  • White
  • United States
  • Terminal Care
  • Retrospective Studies
  • Ovarian Neoplasms
  • Medicare
  • Humans
  • Hospital Mortality
  • Health Services Accessibility
  • Female