Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life

Brown, Crystal; Engelberg, Ruth A.; Sharma, Rashmi; Downey, Lois; Fausto, James A.; Sibley, James; Lober, William B.; Khandelwal, Nita; Loggers, Elizabeth T.; Curtis, J. Randall

doi:10.1089/jpm.2018.0011

Cited by 81 publications

(82 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with Brown et al, 28 we documented extensive racial differences in end-of-life treatment, with Black decedents receiving less hospice care and having more ED visits, hospitalizations, and intensive treatments in the 6 months immediately preceding death compared with White decedents. Although these findings remained even when we accounted for cause of death and other clinical and demographic characteristics in the analysis, we found that racial differences in treatment intensity were especially pronounced among those with noncancer diagnoses.…”

Section: Discussionsupporting

confidence: 89%

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

et al. 2020

View full text Add to dashboard Cite

Key Points Question Are there differences between Black and White patients in the use of hospice and intensity of end-of-life treatment? Findings In this cohort study of 1212 decedents, Black individuals were significantly less likely to use hospice and more likely to have multiple emergency department visits and hospitalizations and undergo intensive treatment in the last 6 months of life compared with White individuals regardless of cause of death. Meaning Despite the increase in the use of hospice care in recent decades, racial disparities in the use of hospice care and the intensity of end-of-life treatment remain.

show abstract

Section: Discussionsupporting

confidence: 89%

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The finding of more aggressive end-of-life care among decedents of Chinese or South Asian ethnicity is similar to the findings of other large-scale quantitative analyses assessing end-of-life care for people from ethnic minorities in North America such as Hispanic or black people. 16,44,45 Although each ethnic group has multiple unique underlying contributors to these findings, some factors such as provider-patient ethnicity discordance, decreased socioeconomic resources and discrimination may be common to different minority ethnicities. 5,46,47 We found contrasting results with respect to receipt of palliative care in the final 6 months of life, with decedents of South Asian ethnicity less likely, and decedents of Chinese ethnicity more likely, to receive palliative care relative to decedents from the general population.…”

Section: Discussionmentioning

confidence: 99%

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Yarnell

Bonares

et al. 2020

CMAJ

View full text Add to dashboard Cite

C ulturally appropriate, patient-focused end-of-life care is an essential component of health care. Despite a preference to die at home, most Canadians die in hospitals and many receive end-of-life care in intensive care units (ICUs). 1-3 Multiple factors contribute to this discrepancy, including uncertainty about the imminence of death, challenges in communication between health care teams and patients and families, poor health literacy and lack of access to palliative care resources. 3-7 These factors may be more pronounced among people from minority ethnic groups. Differences in preferences for intervention at the end of life among ethnic groups may also influence care; the research showing a preference for dying at home included mostly white Canadians. 1 People of Chinese and South Asian ethnicity are the most rapidly growing ethnic groups in Canada, yet little is known about their end-of-life care. 8,9 Comparative studies from the United States have focused on black and Hispanic Americans 8-13 and suggest that minority ethnicity is associated with lower family-rated quality of end-of-life care, 14 increased use of life-support technologies, 13 and decreased use of advanced directives or hospice. 6,12,15-17 Qualitative research describing end-of-life care for people of Chinese or South Asian ethnicities in international settings shows some common themes, including reluctance to share terminal diagnoses, emphasis on collective as opposed to individual decision-making, and attenuation of differences with acculturation. 6,18,19 For people of Chinese ethnicity, research highlights the influence of Confucian philosophy and the role of children in decisions regarding elderly parents. 20-23 For people of South Asian ethnicity, research emphasizes notions of karma, ambivalence toward the cultural appropriateness of hospices or sedating analgesic

show abstract

“…Although policies targeting increased hospice enrollment levels for low-income populations with no specific focus on racial/ethnic minority populations would contribute to the economic savings discussed in this article, prior research has indicated that they would not eliminate the racial disparities within hospice enrollment. Brown et al (2018) showed the effects of race/ethnicity on the intensity of end-of-life care are only partly mediated by other social determinants of health. Another study showed removing racial and ethnic disparities is complex and sometimes well-intended reform initiatives might inadvertently reinforce racial/ethnic disparities (Alegria, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).…”

Section: Discussionmentioning

confidence: 99%

Closing the Gap in Hospice Utilization for the Minority Medicare Population

Hughes

Vernon

2019

Gerontology and Geriatric Medicine

View full text Add to dashboard Cite

Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.

show abstract

Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life

Abstract: The effects of minority race/ethnicity on healthcare intensity at the end of life are only partly mediated by other social determinants of health. Future interventions should address the factors driving both direct and indirect effects of race/ethnicity on healthcare intensity.

Cited by 81 publications

References 25 publications

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

Closing the Gap in Hospice Utilization for the Minority Medicare Population

Contact Info

Product

Resources

About