Palliative care is integral to symptom management, and we examined its relationship with income, education, and Medicaid expansion in AML. This was a retrospective cross-sectional study using the National Cancer Database including patients with acute myeloid and monocytic leukemias > 18 treated at Commission on Cancer facilities from 2004-2016. Univariate and multivariate models were adjusted for demographic variables and facility characteristics. There were 124,988 patients, but only 106,495 had palliative care date, and of this 4,111 (3%) received palliative care. The most educated had the highest odds of receiving palliative care (odds ratio, OR 1.23, 95% CI 1.08-1.41; P = 0.002), but the highest income bracket (≥ $63,333) had the lowest odds (OR 0.82, 95% CI 0.72-0.93; P = 0.003). Residence in states with Medicaid expansion (January 2014 onward) had greater palliative care utilization. Palliative care use was associated with higher education but underutilized with higher incomes. Increased access with Medicaid expansion suggests the importance of public insurance.
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