Hospice Referral Rate Disparities of American Indian/Alaska Native Kidney Transplant Recipients with End-Stage Kidney Disease: A Retrospective Cohort Analysis.
Hossein Moradi Rekabdarkolaee, Lauren E Longacre, Mary J Isaacson and 1 others
PMID 39834019WHAT IT FOUND
Hospice use was significantly lower for American Indian/Alaska Native patients than for non-Hispanic whites, regardless of kidney transplant status.
Transplant recipients used hospice less than non-recipients, but this disparity between transplant and non-transplant groups was significant only for non-Hispanic whites.
Key findings
01Hospice use rates were significantly lower for American Indian/Alaska Native patients compared to non-Hispanic whites in both transplant and non-transplant groups.
02Non-Hispanic whites with prior kidney transplants used hospice significantly less than those without transplants, whereas this difference was not significant for American Indian/Alaska Native patients.
03Place of death varied by hospice status, with hospice users dying at home more often, yet hospital deaths remained common across groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is limited to patients with end-stage kidney disease caused by diabetes, so findings may not apply to other causes of kidney failure. The dataset does not track palliative care use prior to hospice, nor the timing of hospice initiation relative to death. Racial misclassification is a known issue in large medical datasets, which could affect the accuracy of the comparison between groups. The study relies on administrative data and does not capture patient preferences, cultural barriers, or the quality of advance care planning discussions.
Declared interests
The study was approved by the South Dakota State University Institutional Review Board. No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that lower hospice use in transplant recipients applies equally to all racial groups. The significant difference in hospice use between transplant and non-transplant patients was found only for non-Hispanic whites; for American Indian/Alaska Native patients, hospice use was similarly low regardless of transplant status.