End-of-Life Studies

Race is an even stronger predictor of patterns of care than socioeconomic status, suggesting the possibility of different care as well as different cultural attitudes toward death.

Recent studies and surveys paint a picture of disparity when it comes to how and where people of different races and socioeconomic groups die in the United States.

Funding: The Robert Wood Johnson Foundation

Partners: RAND
Here are some of the findings yielded by HRET research:
  • Almost all elderly Americans take advantage of Medicare, but more affluent members of society can afford supplemental health care insurance. Medicare expenditures on whites are substantially greater than those on African-Americans three years prior to death, but significantly less in the last year of life.

  • African-Americans and elderly individuals of lower socioeconomic status tend to experience more aggressive care and incur a disproportionate share of high-cost cases than whites and more affluent elderly individuals.

  • People of higher socioeconomic status are more likely than those of lower socioeconomic status to die from cancer, while Hispanics are less likely to die from cancer than whites.

  • African-Americans are more likely than whites to die from renal failure and diabetes and to die while being hospitalized.

  • Both African-Americans and Hispanics are more likely to die from infectious diseases than whites.

  • African-Americans are more than twice as likely to be dead on arrival at the hospital emergency room than whites and Hispanics.

None of the data has led to the conclusion that disadvantaged populations receive end-of-life care that is equivalent in quality or appropriateness to that received by more affluent populations. What the analysis clearly shows is that a system of nonprice rationing greatly determines care in the last year of life. How and why this came to be is a subject that HRET hopes to address in future research.