Black, Hispanics with HF less likely to receive hospice treatment than Whites

9 March 2010

MedWire News: Black and Hispanic patients with heart failure (HF) are less likely to use hospice care than are White patients, a study of a US national sample of Medicare beneficiaries indicates.

After adjusting for individual and market factors, Blacks and Hispanics had around 41% and 51% lower odds of hospice care, respectively, than Whites.

“Our findings document significant racial and ethnic differences in hospice use and counter speculation that that overall increases in the availability of hospice services in the 1990s may have erased racial and ethnic differences in hospice use,” write the study authors in the Archives of Internal Medicine.

The researchers, led by Jane Givens (Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA), studied hospice entry in the year 2001 among 98,258 Medicare beneficiaries aged 66 years or older, with a diagnosis of HF, who had at least one physician or hospital encounter but no hospice care between 1 January and 31 December 2000.

The overall percentage who used hospice care for any diagnosis in 2001 was small, at 3.9%; of these 18.2% entered because of HF, which varied among ethnic groups, at 18.5% among White patients, 14.1% among Black, and 13.2% among Hispanic patients, and 15.8% among patients of other race or ethnicity.

After adjusting for sociodemographic factors, urbanicity, comorbidities, diagnostic cost group score, use of medical services, and local hospice density, hospice use remained lower among Hispanic (odds ratio [OR]=0.49), Black (OR=0.59), and other non-White beneficiaries (OR=0.64) with HF compared with their White counterparts.

“In addition to sociodemographic, clinical, and geographic characteristics, cultural beliefs and values may contribute to differences between Blacks and Whites in end-of-life care and hospice use,” the authors comment.

“For example, compared with Whites, Blacks are less likely to complete advance directives, have less favorable beliefs about hospice care, opt for more aggressive treatments, and are more likely to have spiritual beliefs that conflict with the goals of palliative treatment.”

They add: “Lack of trust between patients and physicians may be more pronounced for ethnic minorities and may contribute to ethnic differences in hospice entry. It is not clear how many of these differences reflect access issues as opposed to considered patient preferences.”

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Arch Intern Med 2010; 170: 427–432