Sociodemographic Disparities and Impact of Palliative Care Utilization During End-of-Life Hospitalizations in Patients with Gastric Cancer.

Abstract

Gastric cancer is frequently diagnosed at an advanced stage and is associated with high symptom burden. Palliative care can enhance quality of life, provide symptom relief, and support end-of-life planning. However, disparities in access may lead to inequitable care, particularly among vulnerable populations with advanced diseases such as gastric cancer. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2020), a nationally representative database of U.S. hospitalizations, to identify predictors of palliative care utilization and its impact on outcomes among gastric cancer patients who died during hospitalization. Multivariable regression models assessed associations with length of stay (LOS), hospital charges, and intensive interventions. Among 13,435 weighted hospitalizations ending in death, 57.6% received palliative care. Black patients had 32% lower odds of receiving palliative care than White patients (aOR: 0.68, 95% CI: 0.54-0.82). Higher palliative care use was associated with greater income, large hospitals, urban teaching hospitals, and private/other insurance. In adjusted analyses, palliative care was linked to a $36,240 reduction in hospital charges (95% CI: -$51,506 to -$20,974, <i>p</i> < 0.01), with no significant difference in LOS. Palliative care was associated with higher odds of DNR status (aOR: 4.77, 95% CI: 3.99-5.70, <i>p</i> < 0.01) and lower odds of CPR, mechanical ventilation, transfusion, and vasopressor use. Palliative care among hospitalized gastric cancer patients in the United States was associated with less intensive care and lower costs without prolonging LOS. However, significant disparities by race, income, insurance, and hospital type persist. Efforts are needed to ensure equitable access to inpatient palliative care at the end of life.