Racial Differences in Utilisation

The study builds on research that has found racial and ethnic differences in hospice utilization primarily among cancer patients. "Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization," says lead author Jane L. Givens.

Hospice focuses on the active management of pain and other symptoms, as well as the psychological, social and spiritual issues often experienced at the end of life. Hospice is a Medicare benefit; private insurance covers some or most hospice-related expenses.

The study found that blacks had 40 percent lower odds and Hispanics 50 percent lower odds of receiving hospice care for heart failure than whites. The finding is interesting because blacks develop heart failure at a significantly higher rate than either Hispanics or whites, primarily because they have higher rates of diabetes and high blood pressure, two of the leading risk factors for heart failure. A recent study found that young and middle-aged blacks suffer heart failure at a rate 20 times higher than their white counterparts.

Previous studies of hospice utilization have found that geography plays an important role, with patients living in areas with a greater number of minority residents having less access to hospice services. The new study took into account local patterns of hospice use and still found large racial differences in the use of hospice for heart failure.

Givens says the study underscores the need to ensure that there is equal access to hospice services, as well as equal education about hospice, for racial and ethnic minorities. While studies show that cultural beliefs and values may play a role in the hospice-use difference, Givens says that hospice care must be culturally sensitive to be effective.

MEDICA.de; Source: Hebrew SeniorLife Institute for Aging Research