Healthcare Access Dimensions and Racial Disparities in End-of-Life Care Quality among Ovarian Cancer Patients.

Abstract

This study investigated the association between healthcare access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with ovarian cancer (OC). This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER)-linked Medicare data for women diagnosed with OC from 2008-2015, ages 65 years and older. Healthcare affordability, accessibility, and availability measures were assessed at the census-tract or regional levels, and associations between these measures and the quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women (mean age (SD), 77.5 (7.0) years); 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit (ICU) stay (RR 0.90, 95% CI:0.83-0.98) and in-hospital death (RR 0.91, 95% CI:0.84-0.98). After adjustment for HCA dimensions, NHB patients had lower quality EOL care compared to NHW patients, defined as increased risk of hospitalization in the last 30 days of life (RR 1.16, 95% CI:1.03-1.30), no hospice care (RR 1.23, 95% CI:1.04-1.44), in-hospital death (RR 1.27, 95% CI:1.03-1.57), and higher counts of poor-quality EOL care outcomes (Count Ratio:1.19, 95% CI:1.04-1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified.