Social Deprivation and End-of-Life Care Use Among Adults With Cancer

Area of Science:

• Oncology
• Health Services Research
• Health Disparities

Background:

• Racial inequities in cancer outcomes are partly due to socioeconomic factors.
• The relationship between area-level socioeconomic disadvantage, race, and end-of-life (EOL) cancer care quality remains unclear.

Purpose of the Study:

• To investigate the association between socioeconomic disadvantage, race, and the quality of EOL cancer care.
• To understand how these factors influence emergency department visits, intensive care unit (ICU) stays, palliative care consultation (PCC), hospice orders, and in-hospital deaths.

Main Methods:

• Retrospective study of 33,635 adult cancer decedents (2013-2019) from an academic health system.
• Multivariable logistic regression analysis examined associations between decedent characteristics and EOL care indicators.
• Social deprivation index was utilized to quantify area-level socioeconomic disadvantages.

Main Results:

• Racially minoritized decedents had higher odds of ICU stays compared to least deprived White decedents.
• White and Black decedents from deprived areas showed lower odds of emergency department visits.
• While minoritized decedents had higher odds of PCC and hospice orders, White decedents in deprived areas had lower odds of PCC and hospice orders. Greater deprivation was linked to higher odds of in-hospital death, but only among minoritized decedents.

Conclusions:

• Area-level socioeconomic disadvantage does not consistently correlate with poorer EOL cancer care.
• Significant variations exist in EOL care quality based on racial group and socioeconomic status.