This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Medical Practice, Other  • End-of-life Care/ Palliative Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Why Do Minorities Cost More Than Whites?

Amresh Hanchate, PhD; Andrea C. Kronman, MD, MSc; Yinong Young-Xu, ScD, MS; Arlene S. Ash, PhD; Ezekiel Emanuel, MD, PhD

Arch Intern Med. 2009;169(5):493-501.

Background  Racial and ethnic minorities generally receive fewer medical interventions than whites, but racial and ethnic patterns in Medicare expenditures and interventions may be quite different at life's end.

Methods  Based on a random, stratified sample of Medicare decedents (N = 158 780) in 2001, we used regression to relate differences in age, sex, cause of death, total morbidity burden, geography, life-sustaining interventions (eg, ventilators), and hospice to racial and ethnic differences in Medicare expenditures in the last 6 months of life.

Results  In the final 6 months of life, costs for whites average $20 166; blacks, $26 704 (32% more); and Hispanics, $31 702 (57% more). Similar differences exist within sexes, age groups, all causes of death, all sites of death, and within similar geographic areas. Differences in age, sex, cause of death, total morbidity burden, geography, socioeconomic status, and hospice use account for 53% and 63% of the higher costs for blacks and Hispanics, respectively. While whites use hospice most frequently (whites, 26%; blacks, 20%; and Hispanics, 23%), racial and ethnic differences in end-of-life expenditures are affected only minimally. However, fully 85% of the observed higher costs for nonwhites are accounted for after additionally modeling their greater end-of-life use of the intensive care unit and various intensive procedures (such as, gastrostomies, used by 10.5% of blacks, 9.1% of Hispanics, and 4.1% of whites).

Conclusions  At life's end, black and Hispanic decedents have substantially higher costs than whites. More than half of these cost differences are related to geographic, sociodemographic, and morbidity differences. Strikingly greater use of life-sustaining interventions accounts for most of the rest.

Author Affiliations: Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (Drs Hanchate, Kronman, and Ash); Lown Cardiovascular Research Foundation, Brookline, Massachusetts (Dr Young-Xu); and Department of Bioethics, National Institutes of Health, Bethesda, Maryland (Dr Emanuel).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Predictors of Family Conflict at the End of Life: The Experience of Spouses and Adult Children of Persons with Lung Cancer
Kramer et al.
The Gerontologist 2009;0:gnp121v1-gnp121.
ABSTRACT | FULL TEXT