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. 2019 May;36(5):362-369.
doi: 10.1177/1049909118812431. Epub 2018 Nov 20.

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

Amelia Barwise  1   2 , Young J Juhn  3 , Chung-Il Wi  3 , Paul Novotny  4 , Carolina Jaramillo  2   5 , Ognjen Gajic  1 , Michael E Wilson  1   2   6
Affiliations

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

Amelia Barwise et al. Am J Hosp Palliat Care. 2019 May.

Abstract

Background:: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets.

Objective:: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making.

Design/setting/participants:: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014.

Measurements:: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance.

Results:: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives -0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home -0.60(95% CI: 1.0.5-0.72).

Conclusion:: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.

Keywords: HOUSES index; advance directives; decision-making; discharge disposition; end-of-life care; social work referral; socioeconomic status.

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Conflict of interest statement

The authors have not disclosed any potential conflicts of interest.

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