Disparities in Palliative Care Consultations Among Hospitalized Patients with High-Risk Myelodysplastic Syndromes: Analysis of the National Inpatient Sample 2020–2022

Introduction/Background/Significance: Palliative care (PC) improves quality of life and end-of-life outcomes for patients with high-risk myelodysplastic syndromes (MDS), yet utilization patterns and disparities remain poorly understood.

Materials and Methods/Case Presentation/Objective: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) from 2020–2022. We identified adult hospitalizations with high-risk MDS using ICD-10-CM codes (D46.2, D46.21, D46.22, D46.4, D46.7) and receipt of PC consultation using Z51.5. Survey weights were applied to derive national estimates. Multivariable survey logistic regression evaluated associations between social determinants of health (SDOH) — including race/ethnicity, insurance, income quartile, hospital region, and teaching status — and the odds of receiving a PC consultation, adjusting for age and sex.

Results/Description/Main Outcome Measures: Among hospitalized patients with high-risk MDS (1521 patients), only 11.5% received a PC consultation.

Older age was significantly associated with increased PC use (OR 1.04 per year; 95% CI: 1.02–1.06; p< 0.001), while female sex was associated with lower odds (OR 0.65; 95% CI: 0.46–0.92; p=0.015). Compared to rural hospitals, patients treated at urban teaching hospitals had over threefold higher odds of receiving PC (OR 3.62; 95% CI: 1.03–12.70; p=0.044).

There were no statistically significant differences in PC utilization by race/ethnicity or income quartile. However, hospitalizations in the Southern US showed a trend toward higher PC use (OR 1.49; p=0.087), and Medicaid insurance was associated with a non-significant trend toward increased odds (OR 2.07; p=0.095).

Conclusions: Despite guideline recommendations, palliative care remains underutilized among hospitalized patients with high-risk MDS. Notably, older patients and those treated at urban teaching hospitals were more likely to receive PC, while females were less likely. These findings underscore the need to address disparities in PC delivery and to develop targeted interventions ensuring equitable access for all patients with high-risk MDS.