Acute care utilization at the end of life: Does race/ethnicity matter?

Abstract

189 Background: Lung cancer is the leading cause of US cancer deaths. Providing high quality care near end-of-life (EOL) is critical. Hispanic and Black patients with cancer receive less palliative and hospice care referrals and have less knowledge of advance directives compared to non-Hispanic Whites. While it is posited that such inequities can result in disparities in acute care use and goal-discordant care at the EOL among racial/ethnic minority populations, few studies have evaluated whether acute care utilization at the EOL for patients with lung cancer differs by race/ethnicity. Methods: Adult patients with a lung cancer diagnosis who died between 2005-2019 were identified in the California Cancer Registry database linked to a hospital discharge abstracts from the Office of Statewide Health Planning and Development. ICD9/10 codes were used to identify aggressive EOL care defined as: hospital/ED visit, death, intubation, CPR, and dialysis within 14-days of death. Logistic regression models estimated the odds of such care by race and ethnicity. Models were adjusted in apriori considerations of age, income, socioeconomic status, insurance, geography, histology, stage, comorbidities, and care receipt at NCI-designated hospitals. Results: Among 207,429 patients included, mean age was 74 years, 51% were male, 83.6% lived in urban areas, 28% had income 200% below Federal Poverty Level, 48.8% had Medicare, 91.8% received care in a non-NCI designated cancer center and 48.3% had stage IV disease. Black, Hispanic and Asian/Pacific Islander patients compared to Non-Hispanic Whites had increased odds of aggressive EOL care (See Table). Conclusions: This study demonstrates disparities in acute care use and aggressive care delivery among racial and ethnic minorities with lung cancer at the EOL. Solutions are urgently needed to reduce such disparities in care.[Table: see text]