Is Death “The Great Equalizer”? The Social Stratification of Death Quality in the United States

Abstract

Socioeconomic status (SES) gradients in mortality risk are well documented, although less is known about whether the quality of older adults’ dying experiences is stratified by SES. I focus on six core components of a “good death”: pain and symptom management, acceptance, medical care that is concordant with one’s preferences, dying at home, emotional preparation, and formal preparations for end-of-life care. Analyses are based on four data sets spanning the 1980s through 2010s, a period marked by rising economic inequalities: Changing Lives of Older Couples (1986–1994), Wisconsin Longitudinal Study (1993–2010), New Jersey End of Life study (2005–2007), and Wisconsin Study of Families and Loss (2010–2014). I find evidence of SES disparities in two outcomes only: pain and advance care planning (ACP), widely considered an important step toward a “good death.” Implications for health care policy and practice, against the backdrop of the Affordable Care Act implementation, are discussed.