End-of Life Care Disparities Experienced by American Indian and Alaska Natives Peoples: An Analysis of Data from the 2019 Medicare Master Beneficiary Summary File

<b><i>Background:</i></b> American Indian and Alaska Native (AI/AN) adults experience higher rates of chronic diseases and mortality than non-Hispanic White (NHW) adults. Hospice can improve quality of life and reduce hospitalizations for those with terminal illness(es). <b><i>Aims:</i></b> To examine hospitalization and hospice use at the end-of-life between AI/AN and NHW patients and the associations of end-of-life hospitalization and hospice use with chronic diseases. <b><i>Design:</i></b> Using data extracted from the 2019 Medicare Master Beneficiary Summary File, we estimated regression models to examine our aims among patients who died in 2019. <b><i>Setting/Participants:</i></b> Our sample included 6975 AI/AN patients and a 5% sample of 53,465 NHW patients aged ≥65 years. <b><i>Measurements:</i></b> Data included patient demographics, health coverage, date of death, diagnosed chronic conditions, hospital inpatient days, and hospice days. The country of study was the United States. <b><i>Results:</i></b> AI/AN patients at the end-of-life were more likely to be hospitalized and less likely to use hospice compared with their NHW counterparts. For both AI/AN and NHW patients, having a chronic condition was associated with increased hospital days; having dementia and cancer was associated with more hospice days; while diabetes, cardiovascular disease, chronic kidney disease, end-stage renal disease, and liver disease were associated with fewer hospice days. <b><i>Conclusions and Relevance:</i></b> Compared with NHW patients, AI/AN patients received poorer quality end-of-life care. More efforts are needed to understand the barriers and facilitators to hospice for AI/AN patients and in developing strategies that improve access to high-quality end-of-life care for AI/AN patients.