Racial differences in the growth of noncancer diagnoses among hospice enrollees

Patients with noncancer life-limiting illnesses now represent over half of all hospice enrollees, compared to only one-quarter of enrollees in 1992. Whether this growth in enrollees with noncancer diagnoses has been similar for Caucasians and African Americans, a group historically underrepresented in hospice, has not been described. The purpose of this study was to compare rates of noncancer diagnoses among African American and Caucasian hospice enrollees. We analyzed data from the administrative database of VITAS Healthcare Corporation, including all African Americans and Caucasians discharged from hospice between January 1, 1999 and December 31, 2003. Of the 166,390 eligible discharges, 14.6% were African American, and 85.4% were Caucasian. Over the five-year study period, there was a similar increase in the crude proportion of enrollees with noncancer diagnoses in both groups, from 42% to 49.7% among African Americans and 57.9% to 64.3% among Caucasians. However, in multivariate analysis (adjusted for age, gender, admission level of care, payment source, Health Maintenance Organization (HMO) use, discharge year, and hospice program characteristics-size, location, presence of an inpatient unit), African Americans had 32% lower odds of having a noncancer (vs. cancer) diagnosis than Caucasians (odds ratio [OR] 0.68 [0.66, 0.77]). While numerous studies document lower rates of hospice use among African Americans than Caucasians, these findings suggest disease-specific differences in patterns of hospice use, with greater disparities in hospice use among African Americans with noncancer diagnoses than those with cancer diagnoses. Targeted efforts to increase hospice use among African Americans with noncancer diagnoses may be important in reducing racial disparities in overall hospice use and improving the quality of care for dying African Americans.