Practice disparities in palliative care utilization across different solid malignancies in the United States: Geographic trends and impact on hospital outcomes.

Abstract

e24090 Background: Palliative care is a specialized approach for patients with life limiting illness. Utilization disparities reflect differences in disease trajectory, symptoms, practice patterns, access, and socioeconomic or cultural factors. Research is needed to improve care delivery and promote equity. While racial disparities have been studied for some cancers, gaps remain across common tumors and the impact of geographic disparities. Methods: The National Inpatient Sample Database (2016–2020) was analyzed using ICD-10 codes: GI (colon, rectal, anal, gastric, esophageal), GU (kidney, bladder, prostate), lung, breast, and pancreatic cancers. Cohorts were stratified by palliative care use. Primary outcomes included healthcare costs (TOTCHG), hospital length of stay (LOS), and discharge to nursing home (NH) services. Multivariate regression, adjusted for confounders, assessed the impact of palliative care on these outcomes and geographic disparities (Northeast as reference). Results: Palliative care use was highest in lung, followed by pancreatic, GI, breast, and GU cancers. Utilization was higher among Whites (lung 66%, pancreas 69%, GI 65.7%, breast 64%, GU 72%) and lower among Black (15–20%) and Hispanic patients (8–10%) (p < 0.001). Lung cancer had the shortest LOS and lowest TOTCHG; other cancers had longer stays and higher charges. Mortality was highest in GU cancers and lowest in lung cancer. Regionally, use was highest in the South and lowest in the West. Discharge to NH was more frequent in the South and less in the West. LOS > 1 week was less likely in the Midwest and West; TOTCHG was lower in the Midwest, higher in the West. Mortality was higher in the West and lower in the South and Midwest vs the Northeast. Conclusions: Disparities in palliative care utilization, mortality, and resource use exist across cancer types, racial groups, and regions. Low use in the West was associated with higher mortality, while earlier integration in other regions correlated with lower mortality and costs. Findings underscore the need for timely, equitable integration of palliative care to improve outcomes and optimize resources. Geographic disparities in outcomes among palliative care users. Mortality (aOR, 95% CI) Discharge to NH (aOR, 95% CI) Length of Stay > 7d (aOR, 95% CI) Total Hospital Charges (Adjusted β, USD, 95% CI) Midwest: 0.77 (0.69–0.86), p <0.001 Midwest: 1.57 (0.57–4.28), p =0.374 Midwest: 0.90 (0.73–0.87), p =0.008 Midwest: −$19,114 (−$27,875 to −$10,352), p <0.001 South: 0.63 (0.57–0.70), p <0.001 South: 3.00 (1.33–6.79), p =0.008 South: 0.93 (0.87–1.00), p =0.054 South: −$4,868 (−$13,678 to $3,940), p =0.279 West: 1.25 (1.10–1.42), p <0.001 West: 0.68 (0.61–0.76), p <0.001 West: 0.90 (0.83–0.97), p =0.007 West: +$37,623 ($27,002–$48,245), p <0.001 Adjusted for demographics, cardiac comorbidities, and hospital characteristics.