Mount Sinai Researchers Investigate Racial Disparities In End- of Life -Care

In an original investigative study, “Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS cohort,” published in JAMA Open Network today, researchers with the Icahn School of Medicine describe racial disparities at the end of life. Increasingly under scrutiny in medicine, racial disparities are well pronounced during the end of life.

While hospice care has increased substantially in recent years throughout the US, stark racial disparities remain in utilization. The study of 1,212 participants found that black decedents were less likely (34.9 percent) to use hospice than white decedents (46.2 percent). And black decedents were far more likely to receive aggressive care at the end of life. The researchers investigated several manifestations of treatment intensity at the end of life. For example, blacks required emergency room care more than whites (59.3 percent versus 46.4 percent, respectively).  Disparities in end-of-life care were most egregious among deaths due to cardiovascular disease.

“It is critical that we address disparities in quality of care at the end of life, including use of hospice. Despite impressive growth in palliative care and hospice use in the US in recent years, we continue to find that blacks are receiving more burdensome care at the end of life. This is unfortunately not surprising and should be a call to action. The medical community must do more to ensure equal access to high quality end-of-life care including hospice.  Current Medicare guidelines for accessing the hospice benefit, including foregoing curative care, is a barrier to those who have been systematically denied quality healthcare.  Reducing disparities will require improving communication and education around hospice care and ultimately addressing the systemic racism and bias that drive these disparities,” says Katherine Ornstein, MD, PhD, lead author, associate professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.

The researchers analyzed data from the ongoing, population-based National Institutes of Health-funded Reasons for Geographical and Racial Differences in Stroke (REGARDS) study linked to Medicare claims for black and white individuals who had died between January 1, 2013 and December 31, 2015.