Economic Disparities in Palliative Care Utilization Among Cancer Patients in Saudi Arabia: A Socioeconomic Stratification Analysis.

Economic inequities in healthcare access persist globally, yet the impact of income on palliative care (PC) utilization in Middle Eastern contexts remains empirically understudied. This cross-sectional study of 200 cancer patients in Riyadh, Saudi Arabia, employed a socioeconomic stratification analysis to examine income-stratified differences in PC awareness and access. Using chi-square and linear-by-linear association tests, results revealed pronounced income gradients; awareness increased from 41.9% in the low-income group to 71.9% in the high-income group (p = 0.001), demonstrating a significant dose-response trend. Access disparities were even more striking, with only 35.5% of low-income patients utilizing services compared to 76.1% of high-income patients (p < 0.001), representing a 40.6 percentage-point gap. After multivariable adjustment, after controlling for age, gender, education, and geographic living region, the results of logistic regression analysis showed that cancer patients with high income were more than three times as likely to access PC services compared with lower-income cancer patients (OR = 3.32; 95% CI: 1.83-6.02; p < 0.001). Geographic stratification further indicated that income disparities were significantly amplified in peripheral regions compared to the Central region (p = 0.072 for interaction), where service scarcity exacerbates economic barriers. These findings underscore that economic barriers operate through awareness gaps and structural obstacles like transportation and opportunity costs. Addressing these inequities requires multifaceted strategies, including financial support and geographic service expansion, to ensure equitable PC distribution under the Vision 2030 framework.