Racial, Ethnic and Language-Related Disparities in Palliative Care Utilization in Spinal Metastatic Disease

IntroductionStudies indicate racial and ethnic disparities in access to palliative care services. The relationship between race, ethnicity, and associated factors and inpatient palliative care utilization in spinal metastatic disease remains unclear.MethodsWe conducted a retrospective review of electronic health records to identify adult patients diagnosed with spinal metastatic disease at a single institution between January 2004 and December 2024. The primary outcome was inpatient palliative care consultation (IPCC) use. Secondary outcomes included the total number of IPCCs and time to first IPCC since diagnosis. Bivariate analyses and multivariate regression assessed disparities in IPCC utilization.ResultsOverall, 851 patients were included, with 303 (35.6%) having at least one IPCC. Bivariate analyses showed significant differences in IPCC use across racial groups, with White, Asian, Native-American, and 'Other' individuals trending towards lower utilization. Multivariate regression indicated that Native-American race had reduced odds of IPCC encounters (vs White, odds ratio [OR] = 1.16, 95% confidence interval [CI] = [0.12-11.58]) and longer time to first IPCC (Hazard ratio [HR] = 0.58 [0.08-4.19]). Asian (B-coefficient = -0.63 [-3.69-2.43]) and 'Other' race (B-coefficient = -1.26 [-4.19-1.67]), Hispanic ethnicity (vs Non-Hispanic, B-coefficient = -2.24 [-5.17-0.70]), non-English language (vs English, B-coefficient = -0.99 [-4.12-2.14]) and requiring an interpreter (vs not, B-coefficient = -1.38 [-4.64-1.88]) were associated with fewer overall IPCCs.ConclusionsWhile results did not reach statistical significance post-adjustment, our bivariate analyses and the direction and magnitude of associations in regression analyses suggest racial, ethnic and l. Anguage-based disparities in access to palliative care for spinal metastatic disease patients. Further research and policy changes are needed to address these disparities and improve outcomes.