Racial differences in palliative care use and clinical outcomes among hospitalized lung cancer patients: Insights from the 2021 National Inpatient Sample.

Abstract

e24055 Background: Lung cancer remains the leading cause of cancer-related mortality in the U.S., with limited survival despite advances in treatment. Palliative care is integral to improving the quality of life and managing symptoms in patients with advanced lung cancer. However, racial disparities in the utilization of palliative care services may influence clinical outcomes. This study investigates racial disparities in palliative care access and examines their impact on inpatient mortality and length of stay among hospitalized lung cancer patients using data from the 2021 National Inpatient Sample (NIS). Methods: A retrospective cohort study was conducted using the 2021 NIS, including hospitalized patients aged 18 or older with a principal diagnosis of lung cancer (ICD-10 codes: C34.x, D02.20). Patients who received palliative care (ICD-10 code Z51.5) were identified. The primary outcome was inpatient mortality, while secondary outcomes included length of hospital stay (LOS). Racial categories (White, Black, Hispanic, Native American, Other) were compared to assess disparities in palliative care utilization and clinical outcomes, adjusting for sociodemographic factors such as age, gender, income, and primary payer. Results: Among 101,109 hospitalized lung cancer patients, 14% received palliative care. Of those, 74.2% were White, 13.3% Black, 5.8% Hispanic, and 6.7% Other. Black patients were significantly more likely to receive palliative care compared to White patients (adjusted odds ratio 1.2, 95% CI 1.0-1.3, p = 0.046). In terms of clinical outcomes, racial differences were observed in inpatient mortality and LOS. Native American patients who received palliative care had a markedly higher inpatient mortality rate, being 5.4 times more likely to die in-hospital compared to White patients (p = 0.015). Among those receiving palliative care, Black patients had significantly longer hospital stays (mean 2.5 days longer than White patients, p < 0.001). These disparities persisted even after adjusting for comorbidities and socioeconomic status. Conclusions: This study underscores significant racial differences in palliative care use and clinical outcomes among hospitalized lung cancer patients. While Black patients were unexpectedly more likely to receive palliative care, they experienced longer hospital stays, and Native American patients had higher mortality rates. These findings highlight the need for interventions to ensure timely access to palliative care and improve outcomes for underserved racial groups in lung cancer management. However, our study seems limited as data analyzed did not take into consideration the stage of the disease.