• Jennifer S Haas, Craig C Earle, John E Orav, Phyllis Brawarsky, Bridget A Neville, Dolores Acevedo-Garcia, and David R Williams.
• Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120-1613, USA. jhaas@partners.org
• J Gen Intern Med. 2007 Mar 1; 22 (3): 396399396-9.

BackgroundAlthough hospice care can alleviate suffering at the end of life for patients with cancer, it remains underutilized, particularly by African Americans and Hispanics.ObjectiveTo examine whether the racial composition of the census tract where an individual resides is associated with hospice use.DesignRetrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare file for individuals dying from breast, colorectal, lung, or prostate cancer (n = 70,669).MeasurementsHospice use during the 12 months before death.ResultsHospice was most commonly used by individuals who lived in areas with fewer African-American and Hispanic residents (47%), and was least commonly used by individuals who lived in areas with a high percentage of African-American and Hispanic residents (35%). Hispanics (odds ratio 0.51, 95% confidence interval 0.29-0.91) and African Americans (0.56, 0.44-0.71) were less likely to use hospice if they lived in a census tract with a high percentage of both African Americans and Hispanics than if they lived in a low minority tract. African Americans and whites were less likely to receive hospice care if they lived in a census tract with a high percentage of Hispanics than if they lived in a low minority area.ConclusionsIncreasing hospice use may require interventions to improve the delivery of hospice care in minority communities.

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