Ethnic Disparities in Hospice Use Among Asian‐American and Pacific Islander Patients Dying with Cancer

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Abstract
Asian Americans and Pacific Islanders (AAPIs) are a rapidly growing population in the United States, yet little is known about hospice use and length of stay in hospice of older AAPIs dying with cancer. A retrospective study was conducted of the last year of life of AAPI and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results Program. White (n=175,467) and AAPI (n=8,614) patients aged 65 and older who were dying with lung, colorectal, breast, prostate, gastric, or liver cancer were studied. Cox proportional hazards models were used to examine hospice use and length of stay in hospice. All AAPI subgroups studied had lower rates of hospice use (Chinese (adjusted hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.55–0.69), Japanese (adjusted HR=0.67, 95% CI=0.60–0.73), Filipino (adjusted HR=0.61, 95% CI=0.54–0.70), Hawaiian/Pacific Islanders (adjusted HR=0.78, 95% CI=0.67–0.91), and other Asians (adjusted HR=0.70), 95% CI=0.55–0.90) than white patients, adjusting for patient demographic and clinical characteristics. Of those who enrolled in hospice (approximately 20% of the total sample), Japanese Americans had a shorter median length of stay (21 days), and Filipino Americans had a longer median length of stay (32 days) than white patients (26 days). Overall, approximately 20% of patients enrolled within 7 days of death, and only 6% had hospice stays that were longer than 2 months, with no significant differences across racial or ethnic groups. In conclusion, in every ethnic subgroup studied, AAPIs were less likely than whites to enroll in hospice. Further research is needed to understand these differences and eliminate potential barriers to hospice care.