AIM: Hospice care differs among racial, ethnic groups for HF

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Black and Hispanic heart failure (HF) Medicare beneficiaries are less likely to receive hospice care than white patients with the same diagnosis, according to a study published in the March 8 issue of the Archives of Internal Medicine.

Jane L. Givens, MD, of the Beth Israel Deaconess Medical Center in Boston, and colleagues observed data from 98,258 Medicare beneficiaries with HF to evaluate the effect race and ethnicity had on hospice care.

“Underuse of hospice care is well documented, especially among racial and ethnic minorities. Racial and ethnic differences in patients who use hospice care have been found across a spectrum of patients with cancer diagnoses and may be more pronounced in patients with non-cancer diagnoses,” the authors wrote.

Of the Medicare beneficiaries, 88.3 percent were white, 8.5 percent were black, 1.4 percent were Hispanic and 1.8 percent were classified as being of another ethnic and racial group.

Of the 98,258 beneficiaries, 3.9 percent were using hospice care for any diagnosis, while 18.2 percent entered hospice due to HF. Of those who used hospice care (19.9 percent), whites were more likely to be placed in hospice care compared to black and Hispanic beneficiaries: 20.4,15.4 and 16.9 percent, respectively.

The researchers found that blacks had 41 percent lower odds of hospice use and Hispanics 51 percent lower odds of receiving hospice care than whites.

Of the beneficiaries using hospice care, whites were more likely to enter for HF treatment than blacks, Hispanics or other racial and ethnic groups: 18.5, 14.1, 13.2 and 15.8 percent, respectively.

Additionally the researchers found that Hispanics enrolled in hospice had the longest length of care at 19 days. Average hospice care for the other groups lasted 14 days, 13 days and 10 days for blacks, whites and other racial and ethnic beneficiaries, respectively.

“Our findings document significant racial and ethnic differences in hospice use and counter speculation that overall increases in the availability of hospice services in the 1990s may have erased racial and ethnic differences in hospice use,” the authors noted.

During the study, the researchers also adjusted data for sociodemographics, in-hospital interventions, comorbidity and geographic variances. After adjustment, the researchers noted that use of end of life care remained lowest for Hispanic beneficiaries compared to the other groups.

The authors also noted that ethnic minorities may have less trust in their physicians and blacks are less likely to receive adequate information regarding hospice care compared with whites.

“To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior is needed,” the authors concluded.