The Last Inequality: Policy, Institutions, and the Stratification of End-of-Life Quality

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 14. Social Resources and Health

Abstract

The quality of end-of-life experiences may be a site of health equity in later life. Despite growing recognition of unequal quality of care at the end of life, research on death quality tends to focus on single nations and yields inconclusive findings regarding its socioeconomic patterning. To address these gaps, we conducted a cross-national analysis of socioeconomic disparities in death quality across Europe. We focus on the presence and management of pain, breathing problems, and anxiety as indicators of death quality. Using data from the Survey of Health, Ageing, and Retirement in Europe and national-level statistics from Eurostat and the European Values Study, we identified education-based disparities in the management of pain and anxiety, as well as wealth-based disparities in the management of breathing problems. Socioeconomic status patterning is less apparent in outcomes that examine the presence of these symptoms at the end of life. Institutional factors, including long-term care spending, preferences for family caregiving, and reliance on family caregivers, are strong predictors of both the presence and management of end-of-life symptoms and moderate socioeconomic status–based disparities in these outcomes. Overall, our findings show that death quality, evaluated based on the presence and management of end-of-life symptoms, is structured by socioeconomic status and underscore the importance of national contexts in shaping these disparities.

Authors

• Lucie Kalousova, Vanderbilt University

• Zheng (Noah) Lian, Vanderbilt University

• Deborah Carr, Boston University

• Kafayat Mahmoud, Boston University