Physical Function Strongly Associated with Hospital Use at End of Life
Physical Function Strongly Associated with Hospital Use at End of Life
eTable 1. Relative Risk of Any Hospital Admission in the Last 6 Months of Life
Patient Characteristics / Relative Risk of Hospital Admission (95% CI)*Functional Status, reference group Independent
Stable, Moderate debility (1-3 ADL impairments) / 1.04 (0.92,1.15)
Stable, Severe debility (4-6 ADL impairments) / 0.90 (0.81,0.98)
Declined, Independent to Moderate / 1.17 (1.07,1.25)
Declined, Moderate to Severe / 1.02 (0.92,1.10)
Declined, Independent to Severe / 1.12 (1.05,1.20)
Age, reference group <75 years
Age 75-84 years / 0.99 (0.92,1.07)
Age 85 years or more / 0.96 (0.89,1.03)
Female / 0.99 (0.93,1.05)
Race, reference group non-Hispanic white
African American / 1.08 (0.99,1.15)
Hispanic / 1.16 (1.04,1.27)
Medicaid / 0.98 (0.90,1.05)
MediGap (private) / 1.06 (0.99,1.12)
VA coverage / 0.86 (0.75,0.98)
Medical Conditions
Alzheimer’s/Dementia / 0.91 (0.86,0.98)
Cancer / 0.91 (0.84,0.99)
Chronic Kidney Disease / 1.06 (0.99,1.12)
Congestive Heart Failure / 1.09 (1.03,1.15)
Diabetes / 1.06 (1.00,1.12)
Stroke or TIA / 1.02 (0.96,1.10)
Relative Live Nearby / 0.96 (0.91,1.02)
Advance Directive completed / 1.02 (0.96,1.08)
Discussion of end of life care preferences / 1.03 (0.98,1.09)
Hospice Admission within 6 months / 0.91 (0.86,0.97)
Urban Residence / 0.99 (0.92,1.05)
Hospital Beds per 10,000 residents in HRR (mean+1std vs mean-1std) / 1.00 (0.95,1.06)
Specialists per 100,000 residents in HRR (mean+1std vs mean-1std) / 1.07 (1.00,1.13)
Hospital Care Intensity Index (mean+1std vs mean-1std) / 1.06 (0.99,1.14)
* Relative Risk reaches statistical significance (p<0.05) if 95%CI does not include 1.0; statistically significant results are indicated by bold font.
Models also adjusted for the following non-significant variables: Marital status, Education, Net Worth, Nursing Home Residence, Living Alone, Self Rated Health, Ischemic Heart Disease, Atrial Fibrillation, Chronic Obstructive Pulmonary Disease, Depression, and Arthritis.
eTable 2. Number of Hospital Days in Last 6 Months of Life, Conditional on Any
Patient Characteristics / Hospital Days if at least 1 admission, Conditional Difference (95% CI)*Functional Status, reference group Independent
Stable, Moderate debility (1-3 ADL impairments) / -0.05 (-3.13,3.68)
Stable, Severe debility (4-6 ADL impairments) / 6.23 (2.52,10.75)
Declined, Independent to Moderate / 3.55 (0.69,6.64)
Declined, Moderate to Severe / 9.49 (6.03,14.02)
Declined, Independent to Severe / 9.73 (7.01,12.50)
Age, reference group <75 years
Age 75-84 years / -0.13 (-1.84,1.69)
Age 85 years or more / -3.26 (-5.18,-1.21)
Female / -2.07 (-3.86,-0.55)
Race, reference group non-Hispanic white
African American / 6.33 (3.48,9.40)
Hispanic / 3.56 (-0.22,8.37)
Medicaid / -1.37 (-3.19,0.71)
MediGap (private) / 1.84 (-0.01,3.47)
Medical Conditions
Alzheimer’s/Dementia / -2.81 (-4.44,-0.93)
Chronic Kidney Disease / 2.19 (0.40,4.13)
Arthritis / 2.48 (0.74,4.04)
Diabetes / 2.23 (0.59,4.05)
Stroke or TIA / 2.37 (0.35,4.61)
Relative Live Nearby / -1.56 (-3.09,-0.09)
Advance Directive completed / -0.03 (-1.90,1.69)
Discussion of end of life care preferences / -1.43 (-3.17,0.11)
Hospice Admission within 6 months / -1.27 (-2.99,0.08)
Urban Residence / 2.44 (0.71,4.21)
Hospital Beds per 10,000 residents in HRR (mean+1std vs mean-1std) / 1.73 (0.20,3.41)
Specialists per 100,000 residents in HRR (mean+1std vs mean-1std) / 1.69 (0.19,3.16)
Hospital Care Intensity Index (mean+1std vs mean-1std) / 2.12 (0.39,3.94)
* Conditional Difference reaches statistical significance (p<0.05) if 95%CI does not include 0; statistically significant results are indicated by bold font.
Models also adjusted for the following non-significant variables: Marital status, Education, Net Worth, Nursing Home Residence, Living Alone, VA Coverage, Self Rated Health, Ischemic Heart Disease, Congestive Heart Failure, Atrial Fibrillation, Cancer, Depression, and Chronic Obstructive Pulmonary Disease.
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