Introduction: End-of-life and palliative care are often overlooked import aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities with regard to hospice for trauma patients.
Methods: Trauma patients ≥15 from 2012-2015 were queried from NTDB. Chi2 and multivariate logistic regression for disposition to hospice were run controlling for age, gender, co-morbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression with margin commands for LOS was done for all patients discharged to hospice (n=23,612) and patients with polytrauma (ISS>15, n=9,874).
Results: Chi2 of 2,966,444 patients evaluating those transferred to hospice found patients with cardiac disease, bleeding and psychiatric disorders, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and CVA affected transfer (p<0.0001). Logistic regression controlling for covariates showed uninsured were discharged to hospice significantly less than insured patients (OR,0.71; p<0.0001). Asian, Black, and Hispanic patients all received less hospice care than Caucasians (p<0.0001). Negative binomial regression with margins for LOS showed Medicare patients were transferred to hospice 1.2 days sooner than insured patients while uninsured patients remained in the hospital 1.6 days longer (p<0.001). Black patients stayed 3.7 days longer prior to hospice transfer and Hispanics 2.4 days longer (p<0.0001). For polytrauma, Blacks stayed 4.9 days longer and Hispanics 2.3 days longer than Whites (p<0.0001).
Conclusions: Race and ethnicity are independent predictors of trauma patient’s transition to hospice care and significantly affect LOS. Insurance status also predicts hospice access. Prominent racial and socioeconomic disparities exist in the utilization of hospice care services.
