1452 - Racial Disparities in Palliative Care Service Accessibility in Intracerebral Hemorrhage Patients

Objectives: Intracerebral hemorrhage (ICH) is the second-highest cause of stroke-related mortality, and its long-term effects can be difficult for survivors to cope with. Palliative care has emerged as a compassionate, effective strategy to manage critically ill patients by focusing on improving quality of life for patients and their loved ones. This analysis aims to use population-based data to elucidate trends in palliative care service (PCS) utilization.

Design: This analysis utilized pooled data from the 2016-2019 United States Government Agency for Healthcare Research and Quality National Inpatient Sample, which contains >7 million unweighted hospital stays for each year. When weighted, it estimates >35 million hospitalizations yearly (95% of annual American hospitalizations). NIS’ International Classification of Diseases (ICD-10) codes were used for data extraction.

After weighting, 84,840 adult patients admitted with intracerebral hemorrhage were included in analysis. Patients with a hospital stay less than 24 hours were excluded, as they likely passed before being able to receive PCS counseling. T- and chi-square-tests were used to compare groups.

Results: 16,940 (20%) of ICH patients received PCS. Patients who received PCS were significantly older (mean age 75 years, SD 13 vs. 68 years, SD 15, p< 0.001) and were more likely to be female (57.2%, p< 0.001) than patients who did not receive PCS.

Caucasian-ICH patients were significantly more likely to receive palliative care services (p< 0.001). 23% of Caucasian-ICH patients (n=11,940 of 52,125) received PCS. In comparison, only 12% of African-American (n=1,740 of 13,835), 15% of Hispanic (n=1,285 of 8,690), and 19% of Asian/Pacific Islander (n=829 of 4,394) ICH patients received PCS.

Conclusions: Intracerebral hemorrhage patients of racial minority status were disproportionately less likely to receive palliative care services. These findings emphasize the need for improvement in provider- and patient-education or modification of PCS resources to fit patients’ differing cultural needs to improve care accessibility.