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The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses

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  • Christakis, Nicholas A.
  • Iwashyna, Theodore J.

Abstract

Alternative ways of caring for seriously ill patients might have implications not only for patients' own outcomes, but also, indirectly, for the health outcomes of their family members. Clinical observation suggests that patients who die "good deaths" may impose less stress on their spouses. Consequently, we sought to assess whether hospice use by a decedent is associated with decreased risk of death in surviving, bereaved spouses. We conducted a matched retrospective cohort study involving a population-based sample of 195,553 elderly couples in the USA. A total of 30,838 couples where the decedent used hospice care were matched using the propensity score method to 30,838 couples where the decedent did not use hospice care. Our principal outcome of interest was the duration of survival of bereaved widow/ers. After adjustment for other measured variables, 5.4% of bereaved wives died by 18 months after the death of their husband when their deceased husband did not use hospice and 4.9% died when their deceased husband did use hospice, yielding an odds ratio (OR) of 0.92 (95% CI: 0.84-0.99) in favor of hospice use. Similarly, whereas 13.7% of bereaved husbands died by 18 months when their deceased wife did not use hospice, 13.2% died when their deceased wife did use hospice, yielding an OR of 0.95 (95% CI: 0.84-1.06) in favor of hospice use. Our findings suggest a possible beneficial impact of hospice--as a particularly supportive type of end-of-life care--on the spouses of patients who succumb to their disease. Hospice care might attenuate the ordinarily increased mortality associated with becoming widowed. This effect is present in both men and women, but it is statistically significant and possibly larger in bereaved wives. The size of this effect is comparable to the reductions in the risk of death seen in a variety of other modifiable risk factors in women. Health care may have positive, group-level health "externalities": it may affect the health not only of patients but also of patients' family members.

Suggested Citation

  • Christakis, Nicholas A. & Iwashyna, Theodore J., 2003. "The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses," Social Science & Medicine, Elsevier, vol. 57(3), pages 465-475, August.
    • Handle: RePEc:eee:socmed:v:57:y:2003:i:3:p:465-475
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    Cited by:

    1. Yiqing Xing & Clifford Silver Tarimo & Weicun Ren & Liang Zhang, 2022. "The Impact of Health Insurance Policy on the Fertility Intention of Rural Floating Population in China: Empirical Evidence from Cross-Sectional Data," IJERPH, MDPI, vol. 20(1), pages 1-16, December.
    2. Lei Jin & Nicholas Chrisatakis, 2009. "Investigating the mechanism of marital mortality reduction: The transition to widowhood and quality of health care," Demography, Springer;Population Association of America (PAA), vol. 46(3), pages 605-625, August.
    3. Tang, Siew Tzuh & Liu, Tsang-Wu & Lai, Mei-Shu & McCorkle, Ruth, 2005. "Discrepancy in the preferences of place of death between terminally ill cancer patients and their primary family caregivers in Taiwan," Social Science & Medicine, Elsevier, vol. 61(7), pages 1560-1566, October.
    4. José I. Castillo-Manzano & Antonio Sánchez-Braza, 2011. "An Evaluation of the Establishment of a Taxi Flat Rate from City to Airport: The Case of Seville," Urban Studies, Urban Studies Journal Limited, vol. 48(9), pages 1909-1924, July.
    5. Fu‐Min Tseng & Dennis Petrie & Shaolin Wang & Colin Macduff & Audrey I. Stephen, 2018. "The impact of spousal bereavement on hospitalisations: Evidence from the Scottish Longitudinal Study," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 120-138, February.
    6. Hareth Al-Janabi & Job van Exel & Werner Brouwer & Joanna Coast, 2016. "A Framework for Including Family Health Spillovers in Economic Evaluation," Medical Decision Making, , vol. 36(2), pages 176-186, February.
    7. Hareth Al‐Janabi & Job Van Exel & Werner Brouwer & Caroline Trotter & Linda Glennie & Laurie Hannigan & Joanna Coast, 2016. "Measuring Health Spillovers for Economic Evaluation: A Case Study in Meningitis," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1529-1544, December.
    8. Md Saiful Islam & Md Sarowar Morshed & Gary J Young & Md Noor-E-Alam, 2019. "Robust policy evaluation from large-scale observational studies," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-19, October.
    9. Espinosa, Javier & Evans, William N., 2008. "Heightened mortality after the death of a spouse: Marriage protection or marriage selection?," Journal of Health Economics, Elsevier, vol. 27(5), pages 1326-1342, September.
    10. Taylor Jr, Donald H. & Ostermann, Jan & Van Houtven, Courtney H. & Tulsky, James A. & Steinhauser, Karen, 2007. "What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?," Social Science & Medicine, Elsevier, vol. 65(7), pages 1466-1478, October.
    11. Wen, Ming & Cagney, Kathleen A. & Christakis, Nicholas A., 2005. "Effect of specific aspects of community social environment on the mortality of Individuals diagnosed with serious illness," Social Science & Medicine, Elsevier, vol. 61(6), pages 1119-1134, September.
    12. Alastair Canaway & Hareth Al-Janabi & Philip Kinghorn & Cara Bailey & Joanna Coast, 2019. "Close-Person Spill-Overs in End-of-Life Care: Using Hierarchical Mapping to Identify Whose Outcomes to Include in Economic Evaluations," PharmacoEconomics, Springer, vol. 37(4), pages 573-583, April.
    13. Paola Pizzetti & Matteo Manfredini, 2008. "“The shock of widowhood”? Evidence from an Italian population (Parma, 1989–2000)," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 85(3), pages 499-513, February.
    14. Birgitta Andershed, 2006. "Relatives in end‐of‐life care – part 1: a systematic review of the literature the five last years, January 1999–February 2004," Journal of Clinical Nursing, John Wiley & Sons, vol. 15(9), pages 1158-1169, September.
    15. Guccio, C.; & Pignataro, G.; & Romeo, D.; & Vidoli, F.;, 2022. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 22/28, HEDG, c/o Department of Economics, University of York.

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