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Racial/Ethnic Disparities in Hospice Utilization Among Medicare Beneficiaries Dying from Pancreatic Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

We sought to define the incidence and characterize the timing of hospice utilization among racial/ethnic minority patients following pancreatectomy for pancreatic cancer.

Methods

The Medicare Standard Analytic Files from 2013 to 2017 were used to identify patients with pancreatic cancer who underwent a pancreatectomy. Logistic regression was utilized to identify the association between race and patterns of hospice utilization among deceased individuals.

Results

Among the 14,495 individuals (median age 73; 52.3% female; 6.8% racial/ethnic minority) who underwent a pancreatectomy for pancreatic cancer, 47% (n = 6859) died by the end of the follow-period. Among deceased individuals, three-fourths of patients (n = 4978, 72.6%) used hospice leading up to the time of death. Racial/ethnic minority patients were less likely, however, to have used hospice services compared with white patients (racial/ethnic minorities n = 301, 67% vs. whites: n = 4677, 73%; p = 0.024). On multivariable analysis, after controlling for clinical factors, racial/ethnic minority patients remained 22% less likely than whites to initiate hospice services prior to death (OR 0.78, 95% CI 0.63–0.96). Despite overall lower use of hospice, racial/ethnic minority patients had comparable odds of late hospice utilization (i.e., within 3 days of death) versus white patients (OR 1.5, 95% CI 0.73–1.50).

Discussion

While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, racial/ethnic minorities were less likely to use hospice services than whites.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA

    Anghela Z. Paredes, J. Madison Hyer & Elizabeth Palmer

  2. Division of Medical Oncology, Medical Director, Supportive Care Services, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, 1250 Lincoln Tower, Columbus, OH, 43210, USA

    Maryam B. Lustberg

  3. Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA

    Timothy M. Pawlik

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  1. Anghela Z. Paredes
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  2. J. Madison Hyer
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  3. Elizabeth Palmer
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Correspondence to Timothy M. Pawlik.

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Paredes, A.Z., Hyer, J.M., Palmer, E. et al. Racial/Ethnic Disparities in Hospice Utilization Among Medicare Beneficiaries Dying from Pancreatic Cancer. J Gastrointest Surg 25, 155–161 (2021). https://doi.org/10.1007/s11605-020-04568-9

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