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Racial/ethnic disparities in inpatient palliative care utilization and hospitalization outcomes among patients with colorectal cancer

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Abstract

Purpose

Research has shown that racial/ethnic disparities exist in outcomes for colorectal cancer (CRC) patients, but there are no studies assessing inpatient palliative care utilization and hospitalization outcomes in this population. We examined racial/ethnic disparities in palliative care utilization and hospitalization outcomes among CRC and early-onset CRC patients.

Methods

Using National Inpatient Sample (NIS) data collected between 2016 and 2018, cross-sectional analyses were performed. Descriptive analyses were done, stratified by race/ethnicity. Multivariable logistic and linear regression models were used to examine racial/ethnic differences in palliative care utilization, inpatient mortality, chemotherapy/radiotherapy use, length of stay and total hospital charges among hospitalized patients with CRC and early-onset CRC.

Results

Blacks had higher odds (AOR: 1.09; 95% CI: 1.03–1.16) of receiving palliative care consultation while Hispanics had lower odds (AOR: 0.90; 95% CI: 0.84–0.96) compared to Whites. Blacks had 1.1 times higher odds (95% CI: 1.01–1.18) of inpatient mortality relative to Whites while Hispanics had 16% (AOR: 0.84; 95% CI: 0.76–0.93) lower odds of inpatient mortality. Compared to Whites, Blacks (AOR: 1.99; 95% CI: 1.64–2.41), Hispanics (AOR: 2.49; 95% CI: 1.94–3.19) and colorectal cancer patients in the other category (AOR: 1.72; 95% CI: 1.35–2.18) were more likely to receive inpatient treatment with chemotherapy/radiotherapy. Furthermore, Black patients were 1.1 times (95% CI: 1.06–1.14) more likely to have a length of stay more than 5 days. Blacks (𝛃: $3,096.7; 95% CI: $1,207.0–$4,986.5) Hispanic (𝛃: $10,237.5; 95% CI: $7,558.2–$12,916.8) and other patients (𝛃: $6,332.0; 95% CI: $2,830.9–$9, 833.2) had higher hospital charges relative to their White counterparts. Among patients with early onset CRC, Blacks had higher palliative care use (AOR: 1.29; 95% CI: 1.10–1.51) and inpatient mortality (AOR: 1.38; 95% CI: 1.06–1.79) while Hispanics reported $5,589.7 (95% CI: $683.2–$10,496.2) higher total hospital charges and were more likely to receive inpatient chemotherapy/radiotherapy (AOR: 2.48; 95% CI: 1.70–3.63).

Conclusion

Further research is needed to explore specific cultural, socioeconomic, and political factors that explain these disparities and identify ways to narrow the gap. Meanwhile, the healthcare sector will need to assess what strategies might be helpful in addressing these disparities in outcomes in the context of other socioeconomic and cultural factors that may be affecting the patients.

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Data availability

Data to support the findings of this research are publicly available on the Agency for Healthcare Research and Quality website at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.

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Authors and Affiliations

  1. Department of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA

    Inimfon Jackson

  2. Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA

    Inimfon Jackson & Edward Bley

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  1. Inimfon Jackson
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  2. Edward Bley
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Correspondence to Inimfon Jackson.

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Jackson, I., Bley, E. Racial/ethnic disparities in inpatient palliative care utilization and hospitalization outcomes among patients with colorectal cancer. Cancer Causes Control 35, 711–717 (2024). https://doi.org/10.1007/s10552-023-01844-2

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