Race, Socioeconomics Are Largest Barriers to Hospice and Palliative Care

Race, ethnicity and socioeconomic status are the leading differentiating factors fueling disparities in hospice utilization. Recent research reflects mounting concerns about inequitable access to hospice and palliative care across the United States.

Researchers from the John Hopkins University School of Nursing in Baltimore examined March 2020 data from three national health care databases that outlined disparities in hospice and palliative care. Of the studies the researchers assessed across the PubMed, Embase and CINAHL EBSCO databases, 70% described differences in access outcomes to hospice and palliative care by ethnicity, race or socioeconomic status.

According to authors of a 2021 American Journal of Hospice and Palliative Medicine research article, “there is growing evidence of disparities in access to hospice and palliative care services to varying degrees by sociodemographic groups.”


Studies have shown that demographic disparities can limit the scale of hospice. Roughly 82% of Medicare decedents in 2018 were Caucasian, according to the National Hospice & Palliative Care Organization (NHPCO). Comparatively, slightly more than 8% were African-American; 6.7% were Hispanic, and 1.8% were Asian. That year, only 0.4% of Medicare decedents were Native American.

Hospice providers have increasingly strategized to improve access to end-of-life care among these historically underserved populations, seeking to bridge racial divides to hospice and palliative care. Addressing demographic disparities in hospice utilization can ensure more patients receive quality care at the end-of-life, as well as open untapped markets to hospice providers.

According to the study authors, a main objective was to highlight the range of sociodemographic groups affected by inequitable hospice and palliative care access. The research examined disparities across five domains of access, with 60% of studies emphasizing acceptability, affordability and appropriateness as primary barrier points. Other domains included approachability and availability of these services.


Other data included in the body of research found disparate access based on variables such as age, gender and geographic location, such as remote rural areas.

An objective of the study was to outline implications for future research, policy and clinical practices that would improve access for underserved communities.

Underlying factors contributing to disparity issues have received little systematic attention, according to the authors, who indicated that public policy initiatives will be needed to bridge these divides..

“This integrative review highlights the need to consider various stakeholder perspectives and attitudes at the individual, provider, and system levels going forward,” said the study’s authors. “[And] to target and address access issues spanning all domains.”