Racial differences in hospice use revealed

By Sarah Guy

Study results show that while hospice use by Medicare beneficiaries with heart failure increased in the USA over the period 2000 through 2008, non-White patients were less likely to enroll than their White counterparts.

Furthermore, non-White patients had a higher resource use after entering hospice care than White patients, possibly, say the researchers, because compared with White patients, Black patients are more likely to prefer life-sustaining therapies regardless of prognosis.

"Future research should examine whether higher use of acute care services after hospice enrollment among nonwhite patients reflects changing patient preferences or the need for care that the traditional hospice benefit may not be able to provide," suggest Soko Setoguchi (Duke Clinical Research Institute, Durham, North Carolina, USA) and colleagues.

The team believes that other barriers to hospice use among a non-White population could include a lack of awareness of such palliative care services, the possibility that spiritual beliefs may conflict with the goals of hospice care, and a mistrust of the healthcare system.

As reported in the American Heart Journal, Setoguchi and co-authors evaluated hospice and resource use patterns in 219,275 Medicare beneficiaries with heart failure, of whom 24,122 were non-White (including Hispanic and Asian individuals). The participants enrolled in hospice care in the 6 months before they died between 2000 and 2008.

Overall, hospice use increased during the study period in both race groups, rising from 17.0% and 22.1% in non-White and White patients, respectively, in 2000, to 31.8% and 40.4%, respectively, in 2008.

However, the researchers found that non-White patients were 20% less likely than their White peers to enroll.

Of patients who did enroll in hospice during the last 6 months of life, non-Whites were more likely than White patients to visit an emergency department (42.6 vs 33.9%), be hospitalized (46.8 vs 38.5%), and to have an intensive care unit stay (16.9 vs 13.3%).

Indeed, after adjustment for potentially confounding factors including age at death, comorbid conditions in the previous year, and US geographic region, non-White patients were almost 25% more likely to experience each of these outcomes than White patients.

Finally, non-White patients were more likely to disenroll from hospice care than their White counterparts, at 11.6% versus 7.2%, "and those who disenrolled received a greater intensity of services," write Setoguchi et al.

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