Disparities in palliative care among hospitalized patients with hematologic malignancies: A National Inpatient Sample analysis (NIS).

323 Background: Our study aims to identify patient- and hospital-level factors associated with palliative care (PC) use among hospitalized patients with hematologic cancers given its inconsistent use despite increasing recognition of its benefits. Methods: We conducted a retrospective cohort analysis using the NIS database from 2018 to 2022. Adult patients with hematologic cancers and palliative care consult were identified using ICD–10 codes. Adjusted odds ratios using multivariate logistic and linear regression were determined to identify disparities among two cohorts, i.e., overall patients and decedents. Results: Among 40,483,964 hospitalized patients, 683,310 adult patients [male = 390,565 (57.16%)] with hematologic malignancies were identified among whom 61,672(9.03%) had PC use. Of the 40,644 decedents, 22,304 (54.9%) received a palliative consultation. Older age was significantly associated with increased PC use (age 40–59: OR 1.23, p < .03; age ≥60: OR = 1.9, p < .04; Ref: under age 40). Female patients were more likely to receive PC than males (OR = 1.02, p < .01). Relative to White patients, Black (OR 0.9, p= .01), Hispanic (OR = 0.89, p = .01), and Asian or Pacific Islanders (OR = 0.94, p = .02) had lower odds of PC use. Treatment at urban hospitals was associated with higher PC use (urban non-teaching: OR 1.25, p = .02; urban teaching: OR1.39, p < .02) compared to rural hospitals. Increased comorbidity burden was associated with greater PC use (CCI score of 1- 2: OR = 1.35, p < .01 3-4; OR 1.7, p = .02; CCI > 4: OR = 2.11, p= .03 Ref: CCI 0). Among patients who died during hospitalization, age, gender, race, hospital location remained significantly associated with higher PC use. In decedents, when compared to Medicare, Medicaid (OR 1.07; p = 0.04), private insurance (OR 1.21 P = .03) were found to have higher PC use. Regional differences were noted in decedents (Midwest: OR = 1.31, p = .04; West- OR 1.1, p = .03; South: OR 0.91, p = .02; Ref: Northeast). Unlike the overall cohort, patients with higher comorbidity burden had lower odds of receiving PC (CCI 1-2 OR 0.96 p = .04; CCI 3-4: OR = 0.85, p = .003; CCI > 4: OR = 0.81, p = .03) compared to CCI 0. Conclusions: Among hospitalized patients with hematologic malignancies, we identified factors associated with PC use, highlighting socio-demographic disparities. Findings highlight critical gaps in receipt of PC for hospitalized patients with hematologic malignancies and reinforce the need to enhance access to PC in this population.