SUPC-04 DISPARITIES IN PALLIATIVE CARE UTILIZATION AMONG PATIENTS HOSPITALIZED WITH CNS METASTASES: A NATIONWIDE ANALYSIS FROM 2018–2022

Abstract Palliative care is crucial in improving the quality of life for patients with Central Nervous system metastases, but disparities in access may exist across different patient demographics and hospital settings. This study aimed to describe national trends in inpatient palliative care utilization among patients with CNS metastases and assess differences based on race, insurance status, geographic region, and hospital characteristics. A cross-sectional analysis was conducted using the 2018–2022 National Inpatient Sample, identifying adult hospitalizations with CNS metastases using ICD-10 codes. The primary outcome was a receipt of inpatient palliative care services, identified by the V66.7 diagnosis code. Utilization was compared across demographic, socioeconomic, and hospital-level variables, and national estimates were generated using survey weights, with Rao-Scott chi-square tests applied to assess differences in proportions. Among 154,263 weighted hospitalizations for patients with CNS metastases, 24.4% received inpatient palliative care, with significant differences in utilization by race (p < 0.001), insurance type (p < 0.001), and hospital teaching and location status (p < 0.05). Black patients had the highest utilization at 26.7%, while patients of other racial backgrounds had the lowest at 23.2%. Palliative care was more likely among those with no charge or self-pay (28.4% and 26.0%, respectively) compared to those with private insurance (22.7%). No significant difference was found by hospital region (p = 0.163), but rural hospitals had the lowest utilization at 22.8%, compared to urban teaching hospitals at 24.6%. Despite the high symptom burden and limited prognosis of this population, only about 1 in 4 hospitalized patients with CNS metastases received a palliative care consultation, indicating potential underutilization of services. These findings highlight disparities by race, insurance type, and hospital location, emphasizing the need for targeted interventions to ensure equitable access to palliative care for patients with advanced malignancies.