RPD214 - Utilization Patterns of Hospice Care Among Asian Americans, 2016-2020

Key Message : This study examines the utilization of hospice by Asian Americans using Medicare claims. We found that over a third of AAs used hospice before they died, with length of stay slightly increasing from 2016 to 2020. The utilization patterns varied by gender and survival status, but most remarkably across states.

Abstract:

Background: The Asian-American (AA) population is one of the fastest growing minority communities in the US, emphasizing the need to raise awareness of the benefits of hospice care in this population (1).

Objective: To examine utilization of hospice by AAs and explore trends from 2016 to 2020.

Methods: We used Medicare fee-for-service claims of 2016-2020, for patients whose race was ‘Asian/Pacific Islander’. To examine utilization patterns per population, we calculated the average number of hospice stays and length of hospice stays (LOHS). We analyzed these utilization variables by survival status and gender (male/female). Patients with a valid date of death were assigned ‘deceased’ status. Moreover, we explored state-level variations and examined a 5-year trend of hospice usage by AAs. As a sensitivity analysis, we separated older AAs (aged 65 and above) from younger AAs.

Results: Of 1.89 million AAs enrolled in Medicare in 2016, 35% of the deceased (n=47,651) had at least one hospice stay of an average of 40 days. Proportion of hospice usage among the deceased remained consistent from 2017-2020 (from 38% to 37%). Overall, females stayed longer in hospice than males. At the state level, LOHS varied widely from 11 days (South Dakota) to 106 days (Montana) among the deceased, and 18 days (Wyoming) to 283 days (Alabama) among survivors. From 2016-2020, average LOHS increased slightly for the deceased (from 40 to 42 days). Sensitivity results showed that younger AAs were less likely to use hospice care than their older counterparts (24% vs. 36% for the deceased).

Conclusion: Over a third of AAs used hospice care before they died, with LOHS slightly increasing from 2016 to 2020. Utilization of hospice care varied by gender and survival status, but most remarkably across states. Further research should examine the timing, triggering events, and other multi-level factors influencing hospice use.

References: 1. Ngo-Metzger, Q., Phillips, R. S., & McCarthy, E. P. (2008). Ethnic disparities in hospice use among Asian-American and Pacific Islander patients dying with cancer. Journal of the American Geriatrics Society, 56(1), 139–144.