Evaluating Structural and Individual-Level Influences on Black and White Older Adults’ End-of-Life Treatment Preferences

• In Event: 30252 - Racialized Health Injustice

Abstract

Black older Americans are more likely to desire and receive aggressive medical treatments at the end of life, relative to their white counterparts. This disparity is usually attributed to individual or cultural factors, such as family decision making strategies and spiritual beliefs. These explanations fail to consider prior experiences with healthcare providers and healthcare system earlier in the life course, which are likely to shape decision-making at the end-of-life. This study uses the 2018 wave of the Health and Retirement Study experimental module, which collected data on end-of-life preferences from a subset of the core sample. We use multinomial regression models and Kitagawa-Oaxaca-Blinder decomposition to evaluate the relative contributions of individual characteristics and prior experiences of healthcare marginalization on treatment preferences. After controlling for covariates, we find that perceived health care discrimination accounts for significant differences between Black and White American’s preferences for wanting more aggressive treatments. Our study provides compelling novel evidence that preferences for care at the end-of-life are shaped both by individual characteristics and experiences of structural exclusion over the life course.

Authors

• Lucie Kalousova, Vanderbilt University

• Clifford Ross, Vanderbilt University

• Zhe Zhang, Vanderbilt University

• Deborah Carr, Boston University