Online Program

286388
Rural-urban differences in end-of-life medical care cost in older cancer patients


Tuesday, November 5, 2013 : 12:54 p.m. - 1:06 p.m.

Hongmei Wang, PhD, Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
Lina Lander, ScD, Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE
Katherine Watkins, University of Nebraska Medical Center, Omaha, NE
Eugene Boilesen, University of Nebraska Medical Center, Omaha, NE
Monirul Islam, MD, PhD, Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE
Preethy Nayar, MBBS, MS (ENT), MPhil, PhD, College of Public Health, Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE
Fang Qiu, Department of Biostatistics, Unviersity of Nebraska Medical Center, Omaha, NE
Wanqing Zhang, PhD, HSRA, College of Public Health, University of Nebraska Medical Center, Omaha
Shinobu Watanabe-Galloway, PhD, Epidemiology Department, University of Nebraska Medical Center, College of Public Health, Omaha, NE
The objective of this study was to examine whether the cost for end-of-life care for elderly cancer patients was significantly different between rural and urban communities. We analyzed Medicare data for approximately 200,000 older adults (≥66 year old) who had been diagnosed with lung, colorectal, female breast, or prostate cancer and died in 2008. The cost of end-of-life care was quantified as Medicare payments for the last 12 months of care including hospice, inpatient, outpatient, and home health care. End-of-life costs were examined separately for the four cancer sites and linear regression was used to estimate rural-urban differences after adjusting for demographic variables, socioeconomic status, and comorbidities. On average, the last year of medical care for these cancer patients cost Medicare more than $50,000 per patient. Regression results suggested that patients in rural areas spent less in their last one year of life on medical care than their urban counterparts. Patients from minority groups, younger age groups, those with a high socioeconomic status, and those with more complications spent more in their last year of life. The lower Medicare spending in the last year of life for the rural patients suggests disparities in end-of-life care. A further study that delineates the source of the rural-urban difference can help us better understand whether it indicates limited access to appropriate level of palliative care and assist in finding effective policies to reduce the urban-rural disparities.

Learning Areas:

Biostatistics, economics
Provision of health care to the public

Learning Objectives:
Compare end-of-life care costs of older cancer patients living in rural and urban communities

Keyword(s): Cost Issues, End-of-Life Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Hongmei Wang is an Assistant Professor in the Department of Health Services Research & Administration at University of Nebraska Medical Center. Her Ph.D is in health policy with a concentration in economics. Dr. Wang’s research interests focus on socioeconomic determinants of health and economic evaluation of health care programs and medical intervention strategies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4180.0: End-of-Life Care/Issues