Disparities in palliative care consultation among hospitalized patients with diffuse large B-cell lymphoma in the United States: A national analysis from 2016–2022

Abstract

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma and often requires intensive treatment and hospitalization. Palliative care (PC) can improve symptom control and support complex decision-making during serious illness, but access to it is not consistent across all patient populations. In hematologic malignancies like DLBCL, PC remains underused, and it is unclear whether that underuse reflects broader disparities by race, insurance type, or hospital setting. While national PC use has increased over time, less is known about which hospitalized patients with DLBCL are actually receiving these services. This study aimed to evaluate sociodemographic and hospital-level predictors of inpatient PC consultation in this population. Methods: We used the 2016–2022 National Inpatient Sample to identify adult hospitalizations with a diagnosis of DLBCL (ICD-10-CM C83.3) and PC usage (ICD-10-CM Z515). The primary outcome was receipt of inpatient palliative care consultation. We performed survey-weighted logistic regression to identify predictors of PC use, adjusting for age, sex, race/ethnicity, insurance status, income quartile, comorbidity burden (Elixhauser score), and hospital characteristics including region, size, and teaching status. Results: Among 504,370 weighted hospitalizations for DLBCL, 8.3% (n = 41,665) included a PC consultation. Use increased from 6.4% in 2016 to 10.1% in 2022 (p < 0.001). Black and Hispanic patients were significantly less likely to receive PC compared to White patients. These disparities persisted in adjusted models but narrowed after accounting for differences in insurance and hospital characteristics. PC was more likely among patients aged ≥75 (adjusted odds ratio (aOR) 1.48), with higher comorbidity burden (Elixhauser ≥3, aOR 2.15), or those treated at urban teaching hospitals (aOR 1.62). Use was lower among privately insured patients (aOR 0.74), those hospitalized in rural settings (aOR 0.56), and at non-teaching hospitals (aOR 0.68). Conclusions: Despite growing use of inpatient palliative care in DLBCL hospitalizations, access remains uneven. Racial and ethnic disparities appear linked to systemic differences in insurance coverage and hospital resources. Improving availability of palliative services in rural and non-teaching settings, and addressing insurance-related barriers, will be critical to ensuring more equitable care for patients with aggressive hematologic cancers.