Social
Associations between socioeconomic characteristics at the end-of-life and place of death among African Americans diagnosed with cancer: Findings from the Detroit Research on Cancer Survivors (ROCS) study Jamaica Robinson* Jamaica Robinson Nora Akcasu Theresa Hastert
Background: Socioeconomic resources at the end-of-life (EoL) may influence elements of EoL care for African Americans diagnosed with cancer, who disproportionately receive expensive EoL care and experience a hospital-based death relative to other cancer patients.
Methods: Our analyses included 511 decedents who participated in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African Americans diagnosed with incident cancers in Metro Detroit. We measured socioeconomic characteristics – including household income, insurance type (i.e., Medicare, Medicaid, dually eligible), and social risks (i.e., housing instability, food insecurity, utility shutoffs, neighbourhood safety, and not seeking health care because of cost or a lack of transportation) – for the last follow-up survey prior to death. We used these measures in a latent class analysis (LCA) to identify three socioeconomic classes. We assessed place of death via death certificates and categorized decedents as having a hospital- or home-based death. We used modified Poisson models, adjusting for sociodemographics, cancer characteristics, and cause of death, to estimate prevalence ratios (PR) and 95% confidence intervals for associations of socioeconomic class with place of death.
Results: Approximately 35% of decedents were likely to report few social risks, higher annual household income (≥$20K), and Medicare (Class 1); 50% few social risks, lower income (<$20K), and Medicaid or dual eligibility (Class 2); and 15% increased social risks, lower income, and Medicaid or dual eligibility (Class 3). Decedents in Classes 2 and 3 were more marginally more likely than decedents with greater socioeconomic resources to die at home versus in a hospital (PRClass2:1.14, 95% CI:0.89-1.46; PRClass2:1.26, 95% CI:0.91-1.76).
Conclusion: Findings from this study will help to elucidate socioeconomic factors influencing place of death in this socioeconomically and medically marginalized population.