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
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
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.