Race,Ethnicity,Neighborhood Disparities and Palliative Care Utilization: Retrospective Cohort Study

Abstract

Background

Historically palliative care(PC) is utilized less in Hispanic and non-Hispanic Black(NHB) persons compared to non-Hispanic White(NHW). The potential for community and social factors to be fundamental to the disproportionality of disease burden and PC utilization is worthy of exploration.

Aim

Explore the collective impact of race, ethnicity, and neighborhood disadvantage on PC utilization.

Design

Retrospective cohort study utilizing inpatient electronic health records of adult patients now deceased.

Setting/Participants

Included NHB, Hispanic, or NHW adult patients(age>18 years) admitted to midwestern healthcare system hospitals between 2009-2022 for solid cancer, cardiovascular, or cerebrovascular diseases that died within 12 months of hospitalization.

Results

24,243 total patients qualified based upon inclusion criteria(NHW (n = 21,346; 88.05%), NHB(n = 2666;11.00%) Hispanic patients (n = 231;0.95%)). In PC Offered, NHB(OR = 1.36) and Hispanic persons(OR = 1.17) were no less likely to be offered PC than NHW. Higher comorbidity index scores(OR = 1.13%), cerebrovascular disease(OR = 1.13), and do not resuscitate(DNR)(OR = 5.09) were more likely to be offered PC. ADI was not associated with increased likelihood of being offered PC. In PC Accepted, NHB(OR = 1.37), Hispanic(OR = 1.40), cardiovascular (OR = 1.12), cerebrovascular(OR = 1.40), comorbidity index scores(1.11),and DNR(OR = 5.79) were more likely to accept PC.

Conclusion

NHB and Hispanic persons were no less likely to be offered and were more likely to accept PC than NHW. PC services were offered to less than 40% of eligible patients. Of those who were offered PC, over 70% accepted care. The increased likelihood of PC being offered and accepted when comorbidity index scores are higher, and DNR suggests utilization of PC at end-of-life and not throughout serious illness.