C36-15 Racial and Ethnic Disparities in Inpatient Palliative Care Consults in the United States: A Systematic Review and Meta-analysis

Rationale Racial and ethnic disparities in access to hospice and advanced care planning are widely recognized. However, similar evidence in access to inpatient palliative care consultation (PCC) has been mixed—across all fields and within pulmonary and critical care populations. Thus, we sought to systematically review the evidence on inpatient PCC to evaluate for differences by patient race or ethnicity, and identify study or patient factors that may account for the heterogeneity of findings. Methods We searched 6 biomedical databases for studies published from inception to September 2024 that included ≥1 search term from each of four domains: palliative care, inpatient, race/ethnicity, and United States. Paired reviewers independently evaluated all abstracts for inclusion criteria; completed full-text data extraction of population characteristics, study design, and PCC ascertainment method; and rated risk of bias. Disagreements were resolved through discussion or independent adjudication (KRC). Random-effects meta-analysis and mixed-effects meta-regression analyses were performed. Results The database search yielded 2104 unique studies, 47 of which met inclusion criteria and reported PCC by race and ethnicity. All 47 studies reported data for non-Hispanic White patients, 45 for non-Hispanic Black patients, and 39 for Hispanic patients. Forty studies (85.1%) were rated as high risk of bias. A random-effects meta-analysis showed no risk difference in PCC by race (Black - White: -0.0129, p = 0.0526) and a significant risk difference by ethnicity (Hispanic - White: -0.0222, p = 0.0004), with both models demonstrating significant heterogeneity (I2>99.9%, Q > 10000, p < 0.0001). The mixed-effects meta-regression models adjusted for study design and patient factors showed no risk difference in PCC by race (Black - White: 0.0174, p = 0.061) or ethnicity (Hispanic - White: 0.0011, p = 0.9007) and accounted for 55% and 51% of the observed heterogeneity, respectively. Only 8 studies focused on critically ill populations, and an additional 5 studies focused on patients with pulmonary diseases (pulmonary arterial hypertension, acute pulmonary embolism, chronic obstructive pulmonary disease, COVID-19). A random-effects meta-analysis of this subset of 13 studies was similar to the results of the overall cohort (Black - White: -0.0278, p = 0.0097; Hispanic - White: -0.0357, p = 0.0014), though these observed differences could be due to study design and patient factors that were not adjusted for due to sample size. Conclusions This review did not reveal differences in inpatient PCC by race (Black vs. White) or ethnicity (Hispanic vs. White). High risk of bias in most studies and residual study-level heterogeneity limit the conclusiveness of these results. This abstract is funded by: NHLBI T32HL098054