At the End of Life: The Impact and Disparities of Palliative Care Utilization Among Deceased Gastric Cancer Patients in US Hospitals.

OBJECTIVE

The objective of this study was to analyze the characteristics and utilization patterns of palliative care at the end of life among deceased gastric cancer patients, using a large-scale, representative population-based sample from US hospitals.

METHODS

A retrospective analysis was conducted on hospitalization data from the National Inpatient Sample (NIS) covering January 2016 to December 2019. The study population was identified and classified using ICD-10 codes. The objective was to examine the characteristics and disparities related to the provision of palliative care to deceased gastric cancer patients and to assess its impact on healthcare utilization, particularly total hospital charges and length of stay (LOS). Multivariate linear and logistic regression analyses were performed, with the data stratified by age, race, Charlson Comorbidity Index, insurance status, median household income, and hospital characteristics. A P-value of < 0.05 was considered statistically significant.

RESULTS

We identified 33,525 hospitalizations involving patients with gastric cancer. Among these, we identified 2475 gastric cancer patients who died in-patient, of whom 58.38% (n = 1445) received palliative care during their hospital stay at the end of their life. Multivariate linear regression analysis showed that the group receiving palliative care had significantly lower total charges ($108,144 vs. $151,425), with a mean decrease of $43,652 (95% CI - $61,441 to - $25,863, P < 0.001) compared to the group not receiving palliative care. However, there was no statistically significant difference in the adjusted length of stay between patients who received palliative care and those who did not (coefficient =  - 1.00 days, 95% CI - 2.10 to 0.98, P = 0.074). Multivariate logistic regression analysis indicated that patients of Black race had lower odds of receiving palliative care compared to White patients. Patients with private insurance had higher odds of receiving palliative care compared to those with Medicare. There was no statistically significant difference in receiving palliative care based on hospital size, teaching status, or median household income.

CONCLUSION

This study reveals a significant impact and disparities in the provision of palliative care among deceased gastric cancer patients. Those who received palliative care had notably lower total hospital charges, though there was no significant difference in length of stay. Black patients and those with Medicare were less likely to receive palliative care. These findings emphasize the need for targeted interventions to ensure equitable access to palliative care. Future research should investigate the root causes of these disparities and develop strategies to enhance palliative care delivery across diverse patient populations.