Insurance and racial disparities in palliative care utilization and end-of-life outcomes in metastatic pancreatic cancer: A national analysis.

Abstract

e16439 Background: Disparities in palliative care access and end-of-life (EOL) care intensity by insurance and race in metastatic pancreatic cancer remain poorly characterized nationally. Methods: Using the National Inpatient Sample (2019-2022), we identified hospitalizations for metastatic pancreatic cancer (ICD-10: C25.x with C77-C79). Outcomes included palliative care consultation (Z51.5), aggressive EOL care (mechanical ventilation, CPR, vasopressors, dialysis), and in-hospital mortality. Multivariable logistic regression estimated adjusted odds ratios (aOR) by insurance and race. Mediation analysis assessed whether palliative care explained insurance-mortality associations. Results: Among 236,160 hospitalizations (mean age 67.6 years), mortality was 9.6%, palliative care occurred in 27.0%, and aggressive EOL care in 8.0%. Uninsured patients had higher palliative care (aOR 1.43, p < 0.001) yet higher mortality (aOR 1.46, p < 0.001) versus privately insured; palliative care mediated ~40% of this disparity. Medicare patients had lower palliative care (aOR 0.88) and lower mortality (aOR 0.77). Black patients had 70% higher aggressive EOL care odds (aOR 1.70, p < 0.001) despite higher palliative care rates (aOR 1.13). Hispanic and Asian patients showed 44% and 61% higher aggressive EOL care odds, respectively. Conclusions: Uninsured patients receive more palliative consultations yet have higher mortality, suggesting reactive rather than proactive engagement. Black patients experience 70% higher aggressive EOL interventions despite similar palliative exposure. Findings support early palliative integration and culturally-concordant goals-of-care conversations for equitable EOL care. Palliative care disparities. Outcome/Subgroup N Private (%) Medicare (%) Medicaid (%) Uninsured (%) aOR vs Private 95% CI P-value Key Finding Overall Cohort 236,160 — — — — — — — Mean age 67.6y; 65.8% liver mets PALLIATIVE CARE CONSULTATION By Insurance 236,160 23.7 26.8 28.4 32.0 1.43 (Unins) 1.33-1.53 <0.001 Uninsured 43% higher IN-HOSPITAL MORTALITY By Insurance 236,160 10.3 8.5 11.0 14.5 1.46 (Unins) 1.32-1.61 <0.001 Uninsured 46% higher After Palliative Adjustment — — — — — 1.26 (Unins) 1.14-1.40 <0.001 ~40% mediated AGGRESSIVE EOL CARE (Race) Black vs White 236,160 6.7 (W) — — 11.3 (B) 1.70 1.63-1.77 <0.001 70% higher in Black pts Hispanic/Asian vs White — 6.7 (W) — — 10.1/11.7 1.44/1.61 1.37-1.52/1.50-1.72 <0.001 44-61% higher