Geographic and Sociodemographic Disparities in Access to Hospice in Pennsylvania

Context Hospice is a core component of end-of-life care in the United States, designed to provide comprehensive support for patients and their families. While utilization has expanded, concerns remain about whether growth has translated into equitable access. Geographic, socioeconomic, and organizational factors, such as ownership and quality, may shape the availability and type of hospice care patients receive. Objectives To examine geographic and sociodemographic disparities in access to hospice providers across Pennsylvania, a geographically and demographically diverse state. Methods This study used 2023 Centers for Medicare & Medicaid Services (CMS) Provider of Services data to identify hospices by ownership type and quality rating. Provider addresses were geocoded, and 60-minute drive-time catchments were generated. Census tract-level hospice access was assessed using the Getis-Ord Gi* statistic to identify cold spots, defined as clusters of tracts with significantly lower access relative to statewide patterns. Tract-level sociodemographic characteristics were drawn from the 2023 American Community Survey, and mean differences were evaluated using two-sample t-tests. Results In total, 2.3 million Pennsylvanians, or 17% of the state population, reside in census tracts classified as cold spots. Cold spots were concentrated in rural and socioeconomically disadvantaged regions. Compared with other tracts, cold spot tracts were lower income, less educated, older, more reliant on public insurance, and less racially diverse. Patterns were consistent when restricting to high quality hospice and nonprofit hospices. Conclusion Geographic disparities in hospice access compound existing sociodemographic inequities. Addressing these inequities will require efforts to expand high-quality hospice availability in underserved communities.