Differences in Hospice Use Between Black and White Patients During the Period 1992 through 2000

Abstract

We examined differences in hospice use rates among blacks and whites and investigated trends in racial differences in hospice patients during the period 1992 through 2000. We tested differences in length of hospice survival from hospice enrollment to death between black and white patients during this period. We analyzed data from the 1991-2000 Underlying and Multiple Cause-of-Death Files and the 1992-2000 National Home and Hospice Care Surveys using z tests, chi tests, and Cox regression models. Compared with 1992, the hospice use rate doubled for white patients (P < 0.0001) and increased almost 4-fold for black patients (P < 0.0001) in 2000. Hospice use rates among black patients were significantly lower than those among white patients from 1992 to 1994 but not from 1996 to 2000. Black hospice patients discharged throughout the 1990s were more likely to be younger, have Medicaid-only as their payment source, and have HIV/AIDS than their white counterparts. Black hospice patients were more likely to be referred by hospitals than white hospice patients during 1996 to 2000. Throughout the 1990s, length of hospice survival did not significantly differ between black and white hospice patients after adjusting for covariates. Hospice use rates significantly increased for both whites and black patients. Black patients had lower hospice use rates than white patients from 1992 to 1994, but not from 1996 to 2000, which may reflect the diffusion of hospice care to black patients with the rapid growth in hospice programs. Despite differences in patient characteristics, the length of hospice survival was similar among both groups. Future research is needed to assess whether racial disparities exist in quality of hospice care.