Racial differences in end-of-life care for patients with AIDS

This study examines the place of death for persons with AIDS, and the adequacy of the pain treatment that they received in their final months of life. Variations in the use of pain treatment during three months before death and place of death by patient's characteristics such as gender, race/ethnicity, mode of transmission, and geographical location are examined. We used merged AIDS surveillance data and paid Medicaid claims data for the period between 1991 and 1998 to examine the outcomes. Multivariate analysis was done using logistic regressions. Overall, approximately half of the sample received an outpatient prescription for analgesics during the last three months of life. A majority of the decedents (62 percent) died in a hospital. Significant differences in pain treatment and place of death existed between members of racial minority groups and Whites. Higher rates of pain treatment and lower likelihood of dying in a hospital were noted among beneficiaries enrolled in a statewide HIV/AIDS-specific home- and community-based Medicaid-waiver program. Despite financial eligibility, racial minorities, especially African-Americans, were disadvantaged in their access to healthcare services during their last months of life; some of these racial differences appear to be mediated by the use of the waiver program. There was some evidence that access to home care services and case-management mechanisms such as those built into the waiver program were an effective means of facilitating palliative care by increasing the use of pain medication and reducing the likelihood of dying in a hospital.