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Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients
Maya N McKee1, Brett K Palama2, Matt Hall3
1Pritzker School of Medicine, University of Chicago, Chicago, IL.
Insights
Hispanic/Latinx children undergoing stem cell transplants were significantly less likely to receive inpatient palliative care consultations (IPCCs). Addressing systemic racism and social determinants is crucial to reduce these disparities in pediatric palliative care.
Area of Science:
- Pediatric Oncology
- Palliative Care Medicine
- Health Disparities Research
Background:
- Racial/ethnic disparities in adult palliative care utilization are known.
- Understanding these disparities in pediatric palliative care, especially for high-acuity patients like stem cell transplant recipients, is less understood.
- This study addresses the gap in knowledge regarding racial/ethnic differences in pediatric palliative care access.
Purpose of the Study:
- To investigate racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs).
- To examine these disparities specifically within the pediatric stem cell transplant patient population.
- To identify factors associated with IPCC utilization in this cohort.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database.
- Analysis included 1,193 inpatient encounters from 38 tertiary pediatric hospitals in the US (2017-2019).
- A generalized linear mixed effects model assessed demographic and clinical factors associated with IPCC likelihood.
Main Results:
- Only 12% of pediatric stem cell transplant encounters included an IPCC.
- Hispanic/Latinx patients were 59% less likely to receive IPCC compared to non-Hispanic White patients, even after adjustment.
- Malignant conditions and mechanical ventilation were associated with increased odds of receiving IPCC.
Conclusions:
- Significant racial and ethnic disparities exist in IPCC utilization among pediatric stem cell transplant recipients.
- Systemic racism and social determinants of health likely contribute to these disparities.
- Standardizing early IPCC integration may help mitigate these inequities.
Objectives:
Racial/ethnic disparities in utilizing inpatient palliative care services are well documented in the adult literature. However, the impact of racial/ethnic disparities in the context of pediatric palliative care is less well understood even in high-acuity patient populations such as stem cell transplant patients. We investigated racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs) for pediatric stem cell transplant patients.
Study Design:
A retrospective cohort study was conducted using the Pediatric Health Information System database. A generalized linear mixed effects model was developed to assess demographic and clinical characteristics associated with the likelihood of receiving IPCC.
Setting:
Thirty-eight tertiary pediatric hospitals in the United States.
Patients:
Pediatric patients undergoing stem cell transplantation for any indication from January 2017 to December 2019.
Interventions:
None.
Measurements And Main Results:
Of the 1,193 inpatient encounters studied, 12% (n = 143) included a palliative care consult. IPCC rates varied across hospitals with a median rate of 5.97% (interquartile range, 0.00-20.71). In multivariable analyses, Hispanic/Latinx patients were 59% less likely to receive IPCC compared with non-Hispanic White patients (odds ratio [OR], 0.41; 95% CI, 0.21-0.78). This difference persisted after adjusting for all other sociodemographic and clinical factors. In terms of the other clinical characteristics, having a malignant condition and mechanical ventilation were associated with significantly increased odds of receiving IPCC for the entire cohort (OR Malignancy: 1.93; 95% CI: 1.07-3.51; OR Mechanical Ventilation: 2.37; 95% CI: 1.36-4.13). The remainder of the variables were not found to be significantly associated with IPCC.
Conclusions:
Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.
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