Abstract C018: Racial disparities in health care utilization at the end of life among New Jersey Medicaid beneficiaries with advanced cancer
Authors: Yang Annie W , Goldin David , Nova Jose , Malhotra Jyoti , Cantor Joel , Tsui Jennifer 
Published: September 2020

PURPOSE: Quality of cancer care experienced by Medicaid beneficiaries near the end-of-life (EOL) is not well understood. Measures endorsed by national organizations discourage aggressive EOL care and encourage timely referrals to hospice care. We sought to 1) assess the prevalence of aggressive EOL care and hospice enrollment for Medicaid beneficiaries with advanced cancer, and 2) determine whether racial/ethnic disparities exist in patterns of EOL care. METHODS: We used a New Jersey State Cancer Registry-Medicaid claims linked dataset to identify Medicaid beneficiaries (ages 21-64) diagnosed with stage IV breast and colorectal cancer from 2011-2015 and died by January 2016. We measured aggressive EOL care using the four measures: &gt;1 hospitalization, &gt;1 emergency department (ED), any intensive care unit (ICU) admission in the last 30 days before death; receipt of chemotherapy in the last 14 days before death; and a composite measure for “any aggressive care” using the four measures described. We measured hospice enrollment after diagnosis, and hospice enrollment in the last 3 days of life. We used descriptive statistics and multivariate logistic regression models to assess the relationship between race/ethnicity and outcome measures (i.e., rates of aggressive EOL care and hospice use). We adjusted for sex, age at diagnosis, year of diagnosis, length of survival, cancer type, comorbidities, and Medicaid managed care status. RESULTS: We identified 349 patients diagnosed with stage IV breast and colorectal cancer. More than half (56%) identified as a racial/ethnic minority, including 33% Non-Hispanic (NH) Blacks, 18% Hispanics, and 5% NH-Asian Pacific Islanders. Nearly two-thirds of patients (62%) received at least one measure of aggressive EOL care. Almost one-third had &gt;1 hospitalization (27%), &gt;1 ED visit (31%), or were admitted to the ICU (30%) in the last 30 days of life; or received chemotherapy (34%) in the last 14 days of life. Compared to NH-Whites, NH-Blacks had higher odds of receiving any aggressive EOL care (aOR 1.87, 95% CI: 1.08-3.26), &gt;1 hospitalization (aOR 1.98, 95% CI: 1.13-3.47), and &gt;1 ED visit (aOR 1.79, 95% CI: 1.05-3.06), after adjusting for other demographic and tumor characteristics. Among all patients, only 39% of patients enrolled in hospice, while 14% enrolled in hospice in the last 3 days of life. No significant differences in hospice enrollment were observed by race/ethnicity in the multivariate models. CONCLUSION: The majority of Medicaid patients with advanced cancer received aggressive EOL care and did not enroll in hospice. Although all patients in our study were Medicaid beneficiaries, NH-Blacks were twice as likely to receive aggressive EOL care compared to NH-Whites. These racial/ethnic disparities suggest further work is warranted, particularly in larger datasets with greater numbers of diverse cancer patients, to understand the multilevel processes beyond socioeconomic or health insurance status, that lead to suboptimal EOL care.

Citation Format: Annie W Yang, David Goldin, Jose Nova, Jyoti Malhotra, Joel Cantor, Jennifer Tsui. Racial disparities in health care utilization at the end of life among New Jersey Medicaid beneficiaries with advanced cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C018.