Nationwide Trends and Disparities in End-of-Life Care for Acute Myeloid Leukemia: A 2019–2021 NIS Analysis of Palliative Care Utilization and Hospitalization Costs

Purpose: Acute myeloid leukemia (AML) is a high-mortality hematologic malignancy, particularly in older adults. Early palliative care (PC) improves symptom control, quality of life, and outcomes, yet disparities in utilization persist. This study evaluated trends in inpatient PC use among AML patients and associations with mortality, costs, and complications. Patients and Methods: A retrospective cohort analysis was conducted using the 2019-2021 National Inpatient Sample. AML cases were identified via ICD-10 codes and stratified by PC use. The primary outcome was inpatient mortality; secondary outcomes included length of stay (LOS), costs, and complications. Analyses included t-tests, chi-square tests, and logistic regression adjusted for demographic, socioeconomic, and hospital-level factors. Results: Among 2 20 790 AML hospitalizations, 27 540 (12.4%) involved PC. PC recipients were older (67.4 vs 58.7 years, P < .01) and more often White (75.3% vs 70.7%, P < .01). PC use was lower among Black (OR 0.90, P = .05), Hispanic (OR 0.70, P < .01), and Asian (OR 0.77, P < .01) patients. Utilization was highest in urban teaching hospitals (89.2%, P < .01) and Medicare beneficiaries (OR 1.87, P < .01). PC use was associated with higher mortality (37.4% vs 4.4%, OR 11.74, P < .01), longer LOS (12.9 vs 12.3 days, P < .01), increased costs ($214,915 vs $174,193, P < .01), and more complications (all P < .01). Conclusion: PC utilization in AML is associated with poorer clinical metrics, likely reflecting late-stage intervention. Earlier PC integration and addressing disparities are urgently needed to improve equity, outcomes, and resource use in AML care.