Hispanic Hospice Utilization: Integrative Review and Meta-analysis

Hospice is patient-centered end-of-life care. Hispanics are underrepresented among hospice patients (7.1%) relative to the U.S. population (17%). We conducted a systematic review of the literature and meta-analysis to understand this underrepresentation further. In palliative care, Hispanic hospice enrollment is comparable to that of non-Hispanic Whites (NHWs) (RR 1.02, 95% CI: 0.93-1.12; z=0.49; p = .627). However, in cases of heart failure (OR 0.49, 95% CI 0.37-0.66) and stroke (OR 0.77, 95% CI 0.63-0.94), Hispanics are much less likely to use hospice than NHWs. Cancer studies are mixed, but in meta-analysis were significant for lower relative hospice use in Hispanics (RR 0.96, 95% CI: 0.94-0.99; z=3.01; p=.003). It remains unclear whether using census and insurance data in statistical analysis provides valid results since the Hispanic population is younger, healthier, and less likely to be insured. Health equity in hospice may be better represented by hospice quality rather than hospice enrollment rates.