The Intersectionality of Race and Gender in Palliative Care Services Utilization Among Critically-Ill Necrotizing Pancreatitis Patients: Analysis of a Large Nationwide Database in the United States

Abstract

Objective

Necrotizing pancreatitis (NP) is a severe form of pancreatitis that often necessitates intensive care and can result in significant morbidity and mortality. This study aimed to investigate racial and gender disparities in palliative care (PC) utilization among mechanically-ventilated patients with NP.

Methods

In this retrospective analysis using the National Inpatient Sample from 2016 to 2020, we investigated 84 335 patients with NP requiring invasive mechanical ventilation, and the utilization of PC services and their disparities based on gender and race. To adjust for potential confounding factors, we employed multivariable logistic regression, ensuring that our findings account for various influencing variables and provide a robust analysis of the data.

Results

Among the patients studied, 15.4% utilized PC consultations. Notably, female patients were 12% more likely to utilize PC than their male counterparts (OR 1.1, 95% CI: 1.003-1.2; P = .008). Racial disparities were pronounced: African Americans (OR 0.8, 95% CI 0.7-0.9, P < .001), Hispanic (OR 0.8, 95% CI 0.7-0.9, P = .001), and Asian or Pacific Islander patients (OR 0.74, 95% CI 0.57-0.97; P = .03) had significantly lower odds of utilizing PC compared to White patients. The cohort utilizing PC had a higher in-hospital mortality rate (74.7% vs 24.8%; OR 8.2, 95% CI 7.7-9.2) but a shorter mean hospital stays and lower associated costs.

Conclusions

Our findings indicate significant racial and gender disparities in the utilization of PC for intubated patients with NP, with lower utilization among males and minority populations. These findings emphasize the urgent requirement for comprehensive changes in healthcare protocols.

Keywords

gender disparity national inpatient sample necrotizing pancreatitis palliative care racial disparity retrospective analysis

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References

Thomson

van Dijk

Brand

Santvoort

Besselink

. Managing infected pancreatic necrosis. Chirurgia (Bucur). 2018;113:291. doi:https://doi.org/10.21614/chirurgia.113.3.291.

Bugiantella

Rondelli

Boni

, et al. Necrotizing pancreatitis: A review of the interventions. Int J Surg. 2016;28:S163. doi:https://doi.org/10.1016/j.ijsu.2015.12.038.

Baron

DiMaio

Wang

Morgan

. American Gastroenterological association clinical practice update: Management of pancreatic necrosis. Gastroenterology. 2020;158(1):67–75. e1. doi:https://doi.org/10.1053/j.gastro.2019.07.064.

Johnson

. Racial and ethnic disparities in palliative care. J Palliat Med. 2013;16(11):1329–1334. doi:https://doi.org/10.1089/jpm.2013.9468.

Adsersen

Chen

Rasmussen

, et al. Regional and age differences in specialised palliative care for patients with pancreatic cancer. BMC Palliat Care. 2021;20(1):192. doi:https://doi.org/10.1186/s12904-021-00870-8.

Islam

Deveaux

Previs

Akinyemiju

. Racial and ethnic disparities in palliative care utilization among gynecological cancer patients. Gynecol Oncol. 2021;160(2):469–476. doi:https://doi.org/10.1016/j.ygyno.2020.11.031.

Lee

Gani

Canner

Johnston

. Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies. Am J Hosp Palliat Care. 2021;38(6):539–546. doi:https://doi.org/10.1177/1049909120922779.

Paul

Polanco

, et al. Underutilization of palliative care in metastatic foregut cancer patients is associated with socioeconomic disparities. J Gastrointest Surg. 2021;25(6):1404–1411. doi:https://doi.org/10.1007/s11605-020-04742-z.

Cervantes

Jones

Linas

Fischer

. Qualitative interviews exploring palliative care perspectives of latinos on dialysis. Clin J Am Soc Nephrol. 2017;12(5):788. doi:https://doi.org/10.2215/CJN.10260916.

10.

Khan

Zahid

Kichloo

, et al. Gender, racial, ethnic, and socioeconomic disparities in palliative care encounters in ischemic stroke admissions. Cardiovasc Revasc Med. 2022;35:147–154. doi:https://doi.org/10.1016/j.carrev.2021.04.004.

11.

Trikudanathan

Wolbrink

DRJ

van Santvoort

Mallery

Freeman

Besselink

. Current concepts in severe acute and necrotizing pancreatitis: An evidence-based approach. Gastroenterology. 2019;156(7):1994–2007. e3. doi:https://doi.org/10.1053/j.gastro.2019.01.269.

12.

Rowe

Johnston

. Surgical palliative care disparities. Ann Palliat Med. 2022;11(2):86270–86870. doi:https://doi.org/10.21037/apm-20-2394.

13.

Protections (OHRP) O for HR. Federal Policy for the Protection of Human Subjects (‘Common Rule’). Published June 23, 2009. Accessed July 12, 2024. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/common-rule/index.html

14.

Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) NIS Notes [Internet]. hcup-us.ahrq.gov. 2008 [cited 2024 Apr 16]. https://hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp

15.

Dierfeldt

Knopf

Jackson

. Racial disparities at the End of life. afp. 2021;104(4):346–347.

16.

Pierce

. Minority populations and the use of palliative care. Crit Care Nurs Clin North Am. 2022;34(1):19–29. doi:https://doi.org/10.1016/j.cnc.2021.11.002.

17.

Islam

Saraiya

Previs

Akinyemiju

. Health care access measures and palliative care use by race/ethnicity among metastatic gynecological cancer patients in the United States. Int J Environ Res Public Health. 2021;18(11):6040. https://doi.org/10.3390/ijerph18116040.

18.

Sharma

Weissman

Aburayyan

, et al. Sex differences in outcomes of acute pancreatitis: Findings from a nationwide analysis. J Hepatobiliary Pancreat Sci. 2021;28(3):280–286. doi:https://doi.org/10.1002/jhbp.890.

19.

Osakwe

Calixte

Peterson

, et al. Association of hospice agency location and neighborhood socioeconomic disadvantage in the U.S. Am J Hosp Palliat Care. 2024;41(3):309–317. doi:https://doi.org/10.1177/10499091231195319.

20.

Shen

Wang

. Effects of gender on severity, management and outcome in acute biliary pancreatitis. PLOS ONE. 2013;8(2):e57504. doi:https://doi.org/10.1371/journal.pone.0057504.

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