Title

Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date

3-11-2009

Document Type

Article

Subjects

African Continental Ancestry Group; Aged; Aged, 80 and over; European Continental Ancestry Group; Female; *Health Care Costs; Health Expenditures; Healthcare Disparities; Hispanic Americans; Hospice Care; Humans; Male; Medicare; *Minority Groups; Terminal Care; United States

Disciplines

Biostatistics | Epidemiology | Health Services Research

Abstract

BACKGROUND: Racial and ethnic minorities generally receive fewer medical interventions than whites, but racial and ethnic patterns in Medicare expenditures and interventions may be quite different at life's end.

METHODS: Based on a random, stratified sample of Medicare decedents (N = 158 780) in 2001, we used regression to relate differences in age, sex, cause of death, total morbidity burden, geography, life-sustaining interventions (eg, ventilators), and hospice to racial and ethnic differences in Medicare expenditures in the last 6 months of life.

RESULTS: In the final 6 months of life, costs for whites average $20,166; blacks, $26,704 (32% more); and Hispanics, $31,702 (57% more). Similar differences exist within sexes, age groups, all causes of death, all sites of death, and within similar geographic areas. Differences in age, sex, cause of death, total morbidity burden, geography, socioeconomic status, and hospice use account for 53% and 63% of the higher costs for blacks and Hispanics, respectively. While whites use hospice most frequently (whites, 26%; blacks, 20%; and Hispanics, 23%), racial and ethnic differences in end-of-life expenditures are affected only minimally. However, fully 85% of the observed higher costs for nonwhites are accounted for after additionally modeling their greater end-of-life use of the intensive care unit and various intensive procedures (such as, gastrostomies, used by 10.5% of blacks, 9.1% of Hispanics, and 4.1% of whites).

CONCLUSIONS: At life's end, black and Hispanic decedents have substantially higher costs than whites. More than half of these cost differences are related to geographic, sociodemographic, and morbidity differences. Strikingly greater use of life-sustaining interventions accounts for most of the rest.

Rights and Permissions

Citation: Arch Intern Med. 2009 Mar 9;169(5):493-501. Link to article on publisher's site

Journal/Book/Conference Title

Archives of internal medicine

PubMed ID

19273780

Related Resources

Link to Article in PubMed