Exploring Disparities in Palliative Care Utilization for Patients with End-stage Liver Failure: A Nationwide Cohort Analysis (2016-2020)

Background: Despite the very high symptom burden, palliative care (PC) services are underutilized in patients with End-stage liver disease (ESLD). Herein, we investigated the disparities in the utilization of PC services among patients with ESLD hospitalized in the United States. Method: We conducted a retrospective cohort analysis by utilizing the Nationwide Inpatient Sample from 2016 to 2020. All patients greater than 18 years old admitted with ESLD were included in the analysis. A multivariate logistic regression model predicting referral to PC was created. Results: In our analysis, significant racial disparities were observed in the utilization of palliative care services among hospitalized patients with end-stage liver disease (ESLD). Specifically, Hispanic patients were less likely to receive palliative care consultations compared to White and African American patients, with utilization rates of 15.83%, 17.26%, and 17.23% respectively (p < 0.01). Additionally, disparities extended to hospitalization duration and costs; Hispanic patients experienced longer hospital stays (average 22 days) compared to Whites (average 20 days, p < 0.01) and incurred higher hospitalization costs ($76,104 for Hispanics vs. $66,737 for Whites and $67,209 for African Americans, p < 0.01). Notably, mortality rates among patients receiving palliative care were significantly higher across all racial groups compared to those not receiving palliative care (52.76% for Whites vs. 13.95%, 55.45% for African Americans vs. 19.95%, 55.19% for Hispanics vs. 19.03%, all p < 0.01), which likely reflects the selection of patients with more advanced disease for palliative care. Conclusion: There are significant racial disparities in the use of PC services. Further research on the causes of racial disparities is needed to improve access to PC services for the vulnerable ESLD population.