Abstract TP166: The Effect of Race and Socioeconomic Status on End of Life Care

Introduction: Patients from minority racial backgrounds and lower socioeconomic status (SES) often have greater medical mistrust, which may influence end-of-life care decisions including palliative care use and code status. Methods: The National Inpatient Sample (2016–2021) was retrospectively queried to identify patients with an acute ischemic stroke. Patients were stratified by code status and palliative care consultation. Race was dichotomized as either white or non-white. The primary outcomes included the odds of a patient being seen by palliative care, and odds of a patient having a do-not-resuscitate (DNR) code status. Primary outcomes were evaluated using multivariable logistic regression and margins plots adjusted for key clinical and demographic covariates. Secondary outcomes included a non-survey weighted mediation analysis and comparisons of mean NIHSS scores among patients receiving palliative care and those with DNR orders, stratified by race and income quartile. Results: Among 1,313,860 patients, 82,550 (6.28%) had palliative care consultation, and 182,730 (13.9%) had documented DNR status. Of the sample, 896,405 (68.2%) were white and 417,455 (31.8%) non-white; 392,075 (29.8%) were in the lowest and 261,425 (19.9%) were in the highest income quartile. White patients had lower mean NIHSS scores for both palliative care consultation (16.6 vs 17.7, p < 0.001) and DNR status (11.5 vs 14.4, p < 0.001). Similarly, those in the highest income quartile had lower mean NIHSS scores for palliative care consultation (16.3 vs 17.4, p < 0.001) and DNR status (11.2 vs 13.3, p < 0.001). In the logistic regression models, patients from the lowest income quartile had lower odds of palliative care consultation (OR 0.87 95%CI 0.82-0.92, p<0.001) and DNR status (OR 0.75 95%CI 0.72-0.78, p<0.001) compared to those from the highest income quartile. Additionally, patients who were non-white had lower odds of being seen by palliative care (OR 0.63 95%CI 0.60-0.66, p<0.001) and having a DNR code status (OR 0.52 95%CI 0.50-0.54, p<0.001) compared white patients. The mediation analysis showed that increasing NIHSS increased the likelihood of a patient having a DNR status (total effect = 13.73; 95% CI: 12.18-15.47, p < 0.001), with 33.4% of this effect mediated by palliative care. Conclusions: These findings highlight disparities in end-of-life care among non-white, lower SES patients and underscore the need for more nuanced goals-of-care discussions in these populations.