• Press Release

Racial and Ethnic Disparities Found in Palliative Care Use Among Hospitalized Patients With End-Stage Kidney Disease

Less than 3 percent of hospitalized patients with ESKD receive palliative care services, and black and Hispanic patients have the lowest proportion

  • New York, NY
  • (August 06, 2019)

Striking racial and ethnic disparities exist in the use of palliative care  by hospitalized patients with end-stage kidney disease (ESKD) on dialysis, researchers at the Icahn School of Medicine at Mount Sinai report. The findings were published  today in Journal of the American Society of Nephrology.

Palliative care is team-based care focused on improving quality of life and reducing suffering for people with serious illness and their families. Palliative care—which better aligns medical treatments with patients’ goals and wishes, aggressively treats distressing symptoms, and improves care coordination—is associated with shorter hospital stays and lower costs, according to research published in 2018 by scientists at the Icahn School of Medicine at Mount Sinai.

To investigate palliative care use, the researchers conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2006 to 2014, which affords a large pool of minority (black, Hispanic, and Asian) and white patients. The NIS database is the largest, publicly available, all-payer inpatient database in the United States. While the researchers found a clear increase in palliative care utilization for all inpatients with ESKD, they also identified significant variations among minorities compared to white patients which persisted across all hospital subtypes, even hospitals that serve a large proportion of minority patients.

Among the 5,230,865 patients hospitalized during the study period, the palliative care referral rate increased from 0.24 percent in 2006  to 2.7 percent in 2014 among hospitalized patients with ESKD on dialysis. This increasing trend was evident across all racial and ethnic groups; however, white patients had the fastest increase in palliative care utilization, further widening the difference in utilization from that of minorities and resulting in a pronounced divide in 2014: 1.1 percent in black and Hispanic patients versus 2.1 percent in white patients. 

The researchers note that the reasons for the disparities are complex and multifactorial. “One of the unique findings of the study includes the finding that even when minority patients were admitted to hospitals that treat a higher volume of minority patients, they were still less likely to receive palliative care than white patients. Further investigation into the causes of racial disparities is necessary to better understand the systemic issues contributing to barriers to palliative care services in the vulnerable end-stage kidney disease population," says principal investigator Lili Chan, MD, a nephrologist and clinical instructor at the Icahn School of Medicine at Mount Sinai.

“These are striking findings in light of the high mortality rate and  high burden of severe symptoms that patients with ESKD experience such as anorexia, pruritus, dyspnea, and depression. Evidence suggests that symptom-focused palliative care can effectively alleviate these debilitating symptoms,” says principal investigator Girish Nadkarni, MD, Assistant Professor of Medicine (Nephrology), Icahn School of Medicine at Mount Sinai and Clinical Director of the Charles Bronfman Institute of Personalized Medicine, also at Mount Sinai.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.

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