Abstract
Background
This study examined racial and socioeconomic disparities in hospice utilization among deceased older adults in the United States. Hospice care provides comfort-oriented support at the end of life, yet access remains uneven across social groups.
Methods
I used retrospective data from the 2020 RAND Health and Retirement Study (HRS) Exit Interview file in this cross-sectional study. I included 6800 deceased older adults in the analytic sample. I measured hospice use as a binary outcome indicating whether the respondent received hospice care in the final month of life. Key predictors included race/ethnicity, educational attainment, household wealth quintiles, Medicaid enrollment, and private insurance coverage. I used logistic regression models to examine disparities in hospice use, including interaction terms to assess whether SES moderated the effects of race/ethnicity. I computed marginal effects to estimate predicted probabilities.
Results
Non-Hispanic Black and Hispanic older adults were significantly less likely to use hospice services compared to non-Hispanic White peers. After adjusting for SES and health covariates, the disparity for Black adults was no longer statistically significant, but the gap for Hispanic adults persisted (OR = 0.76; 95% CI: 0.60-0.96). Lower education, low household wealth, and Medicaid enrollment were associated with reduced odds of hospice use. Interaction analysis revealed that Hispanic individuals in the lowest SES group had the lowest predicted probability of hospice enrollment (40%; 95% CI: 0.35-0.45).
Conclusion
Findings reveal persistent hospice disparities among marginalized older adults, underlining the need for interventions addressing structural barriers to end-of-life care.
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