Do Racial and Diagnostic Disparities in Hospice Use exist at the End of Life?

STATEMENT OF PROBLEM AND PURPOSE: Hospice appears to be an underutilized service among Blacks compared to Whites and among people with cancer compared to non-cancer diagnoses. However, few studies have examined factors associated with hospice use by race and diagnosis within the same study. This study will determine if racial and diagnostic differences exist in hospice use, duration of hospice use, hospitalizations, ICU/CCU admissions, and emergency room (ER) visits among community-dwelling people 65 years or older at the end of life, after controlling for other factors, within a single study.

THEORETICAL FRAMEWORK: The Hospice Use Model will guide the study.

METHODOLOGY: This secondary analysis will use merged survey, clinical and Medicare claims data from an ongoing longitudinal community study of 10,000 people 65 or older living in a geographically defined metropolitan area. Logistic, linear, and Poisson regression will be used to test four hypotheses related to racial and diagnostic factors associated with the outcomes.

SUBJECTS: Participants are 2,954 people (55% Black; 45% White) who died during the longitudinal study and were enrolled in Medicare for at least 1 year before death.

RESULTS: We anticipate that compared to Blacks and people with cancer, Whites and people without cancer will be more likely to use hospice, will have longer durations of hospice use, and will have fewer hospitalizations, ICU/CCU admissions, and ER visits at the end of life.

IMPLICATIONS: This study will advance the science concerning disparities in hospice use at the end of life and inform future interventions for community-dwelling people.