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Comparative Study
. 2016 Sep;64(9):1789-97.
doi: 10.1111/jgs.14263. Epub 2016 Sep 1.

Racial and Ethnic Differences in End-of-Life Medicare Expenditures

Elena Byhoff  1   2   3   4 , John A Harris  5   6 , Kenneth M Langa  7   8   6   9 , Theodore J Iwashyna  7   8   9   10
Affiliations
Comparative Study

Racial and Ethnic Differences in End-of-Life Medicare Expenditures

Elena Byhoff et al. J Am Geriatr Soc. 2016 Sep.

Abstract

Objectives: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6 months of life.

Design: Retrospective cohort study.

Setting: Health and Retirement Study (HRS).

Participants: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N = 7,105).

Measurements: Total Medicare expenditures in the last 180 days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

Results: The analysis included 5,548 (78.1%) non-Hispanic white, 1,030 (14.5%) non-Hispanic black, and 331 (4.7%) Hispanic adults and 196 (2.8%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35%, P < .001) more for black decedents and $16,341 (42%, P < .001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22%, P < .001) more for black and $6,855 (19%, P < .001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

Conclusion: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6 months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

Keywords: Medicare; disparities; end-of-life; race and ethnicity.

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Conflict of interest statement

Checklist: Elements ofFinancial/PersonalConflicts *Author 1EB Author 2JAH Author 3KML Etc.TJI Yes No Yes No Yes No Yes No Employment or Affiliation x x x x Grants/Funds x x x x Honoraria x x x x Speaker Forum x x x x Consultant x x x x Stocks x x x x Royalties x x x x Expert Testimony x x x x Board Member x x x x Patents x x x x Personal Relationship x x x x output.txt Authors can be listed by abbreviations of their names. For “yes” x mark(s): give brief explanation below: ________________________________________________________ ________________________________________________________

Figures

Figure 1
Figure 1
Modeling Framework for Factors Contributing to Differences in End-of-Life Care.
Figure 2
Figure 2
Predicted Mean Medicare Expenditures in the Last 6 Months of Life by Race/Ethnicity Model (1): Unadjusted analysis of race and total Medicare expenditures. Model (5): Multivariable analysis including all demographic & social supports, socioeconomic factors, geographic factors, illness burden and end-of-life planning variables.
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