Who Dies in the Hospital? Changes in Place of Death Based on Race and Socioeconomic Factors

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 24. Health Knowledge, Behaviors, and Practices

Abstract

Objectives. In the United States, there has been a structural shift in where people die. In the past three decades, deaths occurring in acute care hospitals have declined and deaths occurring in the home have increased. These changes reflect broader cultural and structural shifts that emphasize a need for more comfort-based end-of-life care. It remains unclear whether long standing racial disparities in end-of-life experiences have also changed during this transition. This study examines racial and ethnic disparities in place of death among older adults, with particular emphasis on hospital death, and evaluates the extent to which socioeconomic and social resources explain observed disparities.

Methods. Data are from the Health and Retirement Study (HRS) Exit Interviews conducted between 1995–2022. Our analytic sample included 14,550 decedents (11,095 non-Hispanic White, 2,374 non-Hispanic Black, 1,081 Hispanic). We utilized both multinomial and logistic regression models to estimate associations between race, time period, and place of death. Socioeconomic and social resource variable were added in successive models to test for moderation.

Results. We found that hospital deaths have declined for all groups, but Black and Hispanic decedents are still significantly more likely to die in a hospital, with this disparity remaining stable across the study period. Black and Hispanic decedents were also less likely to die in long-term care facilities. The addition of our socioeconomic and social resource variables did not attenuate racial differences in odds of experiencing a hospital death.

Discussion. Findings suggest that the broad transition toward non-hospital deaths has not translated into meaningful improvements for death quality for all racial and ethnic groups.
Hospital death remains an underexamined site of racial inequality in end-of-life care. Individual-level resources do not explain persistent racial disparities in hospital deaths, pointing to the role of institutional and structural disadvantage as a key driver of end-of-life inequality.

Authors

• Clifford Ross, Vanderbilt University

• Lucie Kalousova, Vanderbilt University

• Deborah Carr, Boston University

• Zheng (Noah) Lian, Vanderbilt University