Abstract C051: Racial and ethnic disparities in end-of-life acute care use among hepatobiliary cancer patients: A 13-year population-based study in California

Abstract Background: Racial and ethnic disparities persist across the cancer care continuum, including at the end-of-life (EOL). Prior studies have shown that minority patients with cancer experience higher rates of intensity of care at EOL compared to non-Hispanic White patients. However, data on whether such disparities exist among patients with hepatobiliary malignancies remain limited. Methods: We conducted a population-based retrospective analysis using the California Cancer Registry linked to hospital discharge data from the Office of Statewide Health Planning and Development. Patients ≥18 years diagnosed with liver or biliary (hepatobiliary) cancers who died between 2005–2018 were included. The primary outcome was the association between race and ethnicity and intensity of care at EOL, defined by ICD-9/10 codes for acute care interventions. Such interventions included the following within 14 days of death: Emergency department/hospital visit, emergency department/hospital death, intensive care unit admission, intubation, cardiopulmonary resuscitation, or dialysis. Multivariable logistic regression models were used to estimate the odds ratio of receiving acute care services by race and ethnicity at EOL adjusting for age, socioeconomic status, insurance, geography, cancer stage, comorbidities, and care at NCI-designated centers. Results: A total of 53,209 patients with hepatobiliary cancer died from 2005-2018 of which 39,646 (74.5%) had liver cancer and 13,563 (25.5%) had biliary cancer. The median age was 68.2 years (range: 20.2-102.3) with 22,888 (43%) non-Hispanic White, 3,680 (6.9%) Black, 5583 (10.5%) Hispanic, and 10,560 (19.8%) Asian/Pacific Islander patients. The majority were male (n=33,722, 63.4%), along with 46,413 (87.2%) who lived in an urban setting, 21631 (40.7%) who had Medicare, 41,782 (78.5%) who received care at a non-NCI designated cancer center, 23,475 (44.1%) who had lower or lower-middle SES, and 11,659 (22.9) who had Stage IV disease. For liver cancer, Black, Hispanic, and Asian/Pacific Islander patients had increased odds of intensity of care at EOL across all interventions except hospital/emergency department death in Hispanic patients and ED visit in Asian/Pacific Islander patients compared to non-Hispanic White patients. For biliary cancer, all groups had increased odds of intensity of care at EOL except for hospital admission and dialysis in Black patients and cardiopulmonary resuscitation and intubation in Hispanic and Asian/Pacific Islander patients. Conclusion: This study demonstrates disparities in intensity of care at the EOL among racial and ethnic minorities with hepatobiliary cancer. Future approaches to EOL should prioritize advanced care planning services and eliminate factors that propagate racial and ethnic disparities in delivery of care. This study underscores the need for targeted, culturally specific interventions to improve equitable access to high-quality, patient-centered care. Citation Format: Khyati S. Dasika, Gladys M. Rodriguez, Manali I. Patel. Racial and ethnic disparities in end-of-life acute care use among hepatobiliary cancer patients: A 13-year population-based study in California [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C051.