Racial disparities in cancer hospice use extend beyond geographic proximity

An observational study published in BMC Medicine examined hospice availability and enrollment among older US Medicare fee-for-service beneficiaries with poor-prognosis cancer in 2018. The analysis included only decedents and used logistic mixed-effects regression accounting for age, sex, race/ethnicity, driving distance to hospice, rurality, neighborhood income, and neighborhood racial composition. Researchers also stratified analyses by race/ethnicity and distance from hospice.

Female, older, and urban beneficiaries had higher odds of hospice enrollment, whereas Black, Hispanic, and Asian beneficiaries had lower odds than White beneficiaries. Neighborhood income and racial composition showed statistically significant interactions with beneficiary race, suggesting that their associations with enrollment differed across groups. Analyses stratified by hospice proximity did not show meaningful effect modification across other predictors.

The findings suggest that distance to a hospice is an incomplete measure of access and that broader structural and sociodemographic factors warrant attention in end-of-life care planning. The observational design cannot establish causality, and the supplied text does not report sample size, enrollment rates, or effect estimates, limiting assessment of the disparities’ magnitude. The study received American Cancer Society funding; the funder had no role in study conduct or manuscript preparation, and the authors declared no competing interests.