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Trends and Disparities in Hospice Use Among Patients Dying of COPD in the United States FREE TO VIEW

Zaid J. Yaqoob, MD; Sadeer G. Al-Kindi, MD; Joe G. Zein, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aRespiratory Institute, Cleveland Clinic, Cleveland, OH

bDepartment of Medicine, University Hospitals, Cleveland Medical Center, Cleveland, OH

CORRESPONDENCE TO: Zaid J. Yaqoob, MD, Respiratory Institute, 9500 Euclid Ave, Cleveland, OH 44195


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1183-1184. doi:10.1016/j.chest.2017.02.030
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We read with interest the article by Rush et al published in the January issue of CHEST. In an analysis of the National Inpatient Sample, the authors showed that palliative care (PC) referrals in patients with COPD who are receiving home oxygen increased from 0.45% in 2006 to 2.56% in 2012. The authors also note that there were significant racial disparities, with whites more likely to be referred for PC. We commend the authors on a well-performed analysis on this important topic.

Given that PC involvement should start early in the course of illness to prevent costs and burden associated with end-of-life hospitalizations, we aimed to share our analysis on the places of death among patients who die of COPD.

Using the US Mortality Files (Centers for Disease Control, National Vital Statistics System), we identified all patients older than 50 years of age who died with COPD as the underlying cause of death (International Classification of Diseases, 10th revision, code J44.x) from 2006 to 2015. We identified the trends and sex and racial disparities in locations of death. The Spearman correlation was used to identify Ptrend, and the χ2 test and logistic regression were used to evaluate disparities.

A total of 1,242,350 patients died of COPD during the study period (33.6% inpatient, 28.6% at home, 22.5% nursing home/long-term care, 5.9% hospice, 0.4% dead on arrival at hospital, and 4.5% other/unknown). COPD accounted for 6.1% of all hospice deaths among patients 50 years or older.

Overall, the percentage of hospice deaths among patients with COPD increased from 2.2% in 2006 to 9.3% in 2015 (Ptrend < .001) (Fig 1). Hospice deaths increased with age (OR, 1.04; 95% CI, 1.03-1.04 per 5-year increment; P < .001). Female patients were more likely to die in hospice compared with male patients (6.1% vs 5.7%; P < .001), and whites were more likely to die in hospice than were African Americans (6.1% vs 4.2%; P < .001). There were also significant regional variations in percentages of hospice deaths (Northeast, 4.1%; Midwest, 4.7%; South, 8.1%; West, 4.7%; P < .001). The total number of patients who died of COPD in hospices during 2015 was 13,101 patients.

Figure Jump LinkFigure 1 Percentage of patients with COPD dying in hospice (2006-2015).Grahic Jump Location

Thus, we show that the trends reported by Rush et al in PC use mirrored the percentage of COPD deaths in hospices. Despite this, only a minority of patients with COPD die at home or in hospice. Early PC involvement in patients with severe COPD may improve the end-of-life experience and increase hospice use.

References

Rush B. .Hertz P. .Bond A. .McDermid R.C. .Celi L.A. . Use of palliative care in patients with end-stage COPD and receiving home oxygen: national trends and barriers to care in the united states. Chest. 2017;151:41-46 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 Percentage of patients with COPD dying in hospice (2006-2015).Grahic Jump Location

Tables

References

Rush B. .Hertz P. .Bond A. .McDermid R.C. .Celi L.A. . Use of palliative care in patients with end-stage COPD and receiving home oxygen: national trends and barriers to care in the united states. Chest. 2017;151:41-46 [PubMed]journal. [CrossRef] [PubMed]
 
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