Low Socioeconomic Status Associated with Lower Utilization of Hospice Care Services during End-of-life Treatment in Cancer Patients: A Population-based Cohort Study.

Abstract Context Socioeconomic status (SES) is an important determinant of disparities in health services and may affect the utilization of hospice care services during end-of-life (EOL) treatment in cancer patients. However, previous studies evaluating the association between SES and utilization of hospice care services among cancer patients revealed inconsistent findings. Objectives This study aimed to determine the association between SES and utilization of hospice care services during the last year of life in cancer patients. Methods From January 1, 2006, through December 31, 2016, we identified adults with cancer diagnoses from the Registry for Catastrophic Illness in Taiwan. The cancer diagnoses in study subjects were proved by the pathohistological reports. The utilization of hospice care services during the last year of life in cancer patients included hospice inpatient care, hospice-shared care, and hospice home care. Results In the follow-up period, 28.6% of 516,409 cancer patients utilized hospice care services during the last year of life. After adjusting for other covariates, low SES significantly reduced the utilization of hospice care services by 18% during the last year of life in cancer patients. Moreover, a positive trend between decreasing levels of SES and lower utilization of hospice care during EOL treatment was noted (P Conclusions Low SES was associated with lower utilization of hospice care services during EOL care in cancer patients. Our data support the need to target low SES cancer patients in efforts to optimally increase hospice care services during EOL care.