Hospice use among patients with HF varied by race, ethnicity

Blacks and Hispanics were less likely than whites to use hospice care for HF, even after adjusting for sociodemographic factors, according to findings from a large prospective cohort study involving a nationally representative sample of Medicare beneficiaries.

U.S. researchers analyzed hospice use among 98,258 beneficiaries who had a diagnosis of HF and at least one physician or hospital encounter and who were not enrolled in hospice care between Jan. 1 and Dec. 31, 2000. The primary outcome variable was entry into a hospice with an admitting HF diagnosis between Jan. 1 and Dec. 31, 2001. The cohort represented approximately 2.7 million beneficiaries and was composed of the following racial/ethnic groups: white (weighted percentage, 88.3%), black (8.5%), Hispanic (1.4%) and other (1.8%).

The researchers found that the overall percentage of beneficiaries that used hospice care for any diagnosis was 3.9%, with 18.2% entering care due to HF. After adjusting for markers including income, urbanicity, illness severity, local hospice-use density and medical comorbidity, the researchers found that blacks (14.1%; adjusted OR=0.59; 95% CI, 0.47-0.73) and Hispanics (13.2%; adjusted OR=0.49; 95% CI, 0.37-0.66) used hospice care for HF less vs. whites (18.5%).

These findings reflected similar racial and ethnic disparities in hospice-care use already identified among patients with cancer.

“To our knowledge, our study is the largest longitudinal cohort study examining factors associated with hospice entry for a noncancer diagnosis,” the researchers wrote. They called for further study of patient preferences and physician referral behaviors to better understand underlying factors that may have influenced the findings and noted that cultural beliefs and values may play a role.

Givens JL. Arch Intern Med. 2010;170:427-432.

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