Elderly/Long-term Care

Elderly cancer patients who live in minority communities use hospice care less than their counterparts in white communities

Hospice care can alleviate suffering at the end of life for patients with cancer. However, it remains underused, especially by blacks and Hispanics. Medicare-insured elderly patients with cancer who live in communities with a greater percentage of minorities are less likely to use hospice care than those who live in areas with fewer minorities, regardless of individual socioeconomic and clinical characteristics.

A recent study suggests that there may be inadequate resources and services to provide hospice care in minority neighborhoods. For instance, pharmacies may not stock quantities of opioids needed to treat the severe pain that is often experienced by cancer patients at the end of life.

Researchers analyzed Surveillance, Epidemiology, and End Results (SEER) Medicare files for individuals dying from breast, colorectal, lung, or prostate cancer. They examined whether the racial composition of the census tract where an individual resided was associated with hospice use. Nearly half (47 percent) of individuals who lived in areas with fewer black and Hispanic residents used hospice compared with only one-third (35 percent) of those who lived in areas with a higher percentage of black and Hispanic residents.

Hispanics and blacks were 49 percent and 44 percent, respectively, less likely to use hospice if they lived in a census tract with a high percentage of both blacks and Hispanics than if they lived in a low minority tract. Blacks and whites were less likely to receive hospice care if they lived in a census tract with a high percentage of Hispanics than if they lived in a low minority area.

These differences in hospice use may contribute to disparities in suffering at the end of life and caregiver burden in high minority neighborhoods. Interventions to improve resources as well as the social acceptance of hospice care in minority communities may improve use of hospice care in the United States.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10856).

See "Lower use of hospice by cancer patients who live in minority versus white areas," by Jennifer S. Haas, M.D., M.S.P.H., Craig C. Earle, M.D., John E. Orav, Ph.D., and others, in the March 2007 Journal of General Internal Medicine 22, pp. 396-399.

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