Socioeconomic Trends in Palliative Care: A Six-Year Study

The use of palliative care (PC) is on the rise in the USA, with clear benefits to patients, families, hospitals, and insurance companies. Our study investigates trends in PC utilization, focusing on socioeconomic characteristics. The National Inpatient Sample (NIS) from 2015 to 2020 was used to identify adults hospitalized in the United States (US). International Classification of Diseases, Tenth Revision (ICD-10), was used for PC encounters, code Z51.5. An equal number of random records, stratified by year and without this code, were selected to serve as controls. Records were analyzed for baseline characteristics using a chi-square test. Adjusted odds ratios (ORs) of receiving PC were calculated using multivariate logistic regression. Men were more likely to receive PC consults (OR: 1.07, confidence interval (CI): 1.06-1.08). Medicare/Medicaid holders' PC access was limited compared to private insurance holders (0.89, 0.86-0.93). Racial minorities, particularly Hispanics (0.9, 0.86-0.95) and Blacks (0.83, 0.77-0.88), were less likely to engage in PC. Compared to urban teaching hospitals, rural hospitals had a decreased rate of PC utilization (0.53, 0.49-0.57). Smaller hospitals had significantly fewer PC referrals than large hospitals (0.80, 0.76-0.85). A lower socioeconomic status was associated with a reduced propensity to utilize PC services compared to an upper socioeconomic status (0.91, 0.87-0.96). Our analysis shows that socioeconomic factors strongly influence PC access. This highlights important inequities that require measures to improve equitable PC access across demographic groups.