Comparing Rural Versus Urban Pediatric Hospice Recipients, 2011 to 2022

Pediatric hospice care is essential in supporting children with life-limiting conditions and their families during the last year of life, yet little is known about how geographic location influences the characteristics of children receiving care. This study examined differences between rural and urban pediatric hospice recipients using a pooled cross-sectional Medicaid dataset from 2011 to 2022. Guided by the socioecological framework, data from 17,134 deceased Medicaid-enrolled children aged 20 years and younger who received hospice services in the Midwest and Southern United States were analyzed. Rural children demonstrated greater clinical complexity, including higher rates of physical and mental health multimorbidity, technology dependence, and polypharmacy. Despite lower rates of inpatient admissions and emergency department visits, rural children received care from larger medical teams, more subspecialists, and incurred higher outpatient and primary care costs. They also lived in communities characterized by greater economic disadvantage, lower internet connectivity, longer distances to health care resources, and higher rates of residence in Appalachian and medically underserved areas. These findings suggest that rural pediatric hospice recipients experience a convergence of heightened medical complexity and structural barriers to care.