Racial Disparities Persist Among Palliative Patients with Kidney Disease

Patients of color suffering from advanced kidney disease are underrepresented among palliative care patients, recent research has found. Outreach to these communities can improve patients’ quality of life as well as expand providers’ market penetration.

Palliative care utilization among hospitalized patients suffering from end-stage kidney disease has risen overall, the study found, but black and Hispanic patients were far less likely than white patients to receive a referral.

Researchers used data from the U.S. Agency for Healthcare Research and Quality’s National Inpatient Sample to conduct a retrospective cohort study of 5.2 million patients on dialysis who were hospitalized between 2006 and 2014.


Rates of referrals for black and Hispanic patients rose 0.21% and 0.22% respectively, year over year, whereas referrals for white patients rose by nearly double that percentage at 0.41%.

The study appeared in the August issue of the Journal of the American Society of Nephrology.

“The reasons of racial disparities in the use of palliative care services in [end-stage kidney disease] patients are complex, likely multifactorial and still under investigation,” Yumeng Weng, M.D., one of the study’s co-authors and a physician at Johns Hopkins University, told Hospice News. “Dissatisfaction with clinical care and distrust of health care providers have been suggested in other studies as barriers for African American patients to receive palliative care. It is also possible that cultural sensitivity and language barriers play their roles in certain minority populations, especially Hispanic patients.”


Socioeconomic factors may play a significant role in determining which patients receive palliative care referrals. Minority patients who had a high income or private insurance received a similar rate of referrals compared to white patients.

Similar disparities exist among hospice patients, regardless of their primary diagnosis.

Nearly 87% of Medicare decedents in 2016 were caucasian, according to the National Hospice & Palliative Care Organization (NHPCO). Comparatively, slightly more than 8% were African-American; 2.1% were Hispanic, and 1.2% were Asian. That year, only 0.2% of Medicare decedents were Native American.

“The business challenge of hospice care is to transform care and services to meet a more dynamic mix of people of various races, cultures and backgrounds. Improved and equitable business practices are needed to meet the needs of all hospice consumers and employees,” an NHPCO diversity report said. “As hospices strive toward access for all, the business base of your organization will become more diverse. New populations will gain knowledge of your services. Your leaders will need increasing business expertise to meet new population and market challenges.”

Researchers agree that more study is needed to determine what actions health care providers can take to address these disparities.

The causes for these disparities are only suggested with indirect evidence. Therefore, further study is needed to determine if the aforementioned and other factors are contributing to these disparities,” Lili Chan, M.D., a study co-author from the Icahn School of Medicine at Mount Sinai in New York, told Hospice News. “Potential interventions include increasing diversity in the workforce and institution of unconscious bias and diversity training. In addition, ensuring continuity of care to improve patients’ satisfaction, improving cultural sensitivity as well as improving coverage for certain inpatient hospice services by non-private insurance may also help to address these disparities.”

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