Racial and Ethnic Differences in End-of-Life Costs

Abstract

Racial and ethnic disparities pervade US health care.^1-9 Many studies show blacks and Hispanics receiving fewer medical services and spending less than whites. For example, minorities receive fewer cardiac procedures, prescriptions for life-saving medications, and narcotic medications for pain relief. Despite efforts by policy makers to address these disparities, they persist.^5,10 At the end of life, however, this pattern may be reversed.¹¹ Several studies have found higher Medicare costs and service use for nonwhites at life's end.^2,12-16 These studies examined differences in sociodemographic and geographic factors as contributors to these disparities. Shugarman et al¹⁴ reported that in the 2 years before the last year of life, spending by blacks was significantly lower. However, in the last year, this deficit “flipped”; estimated final-year spending was 19% higher for blacks than for whites (P = .10). They did not study Hispanics.