Racial and ethnic differences in advance care planning: identifying subgroup patterns and obstacles

Area of Science:

• Sociology of Health
• Health Disparities Research
• Public Health Policy

Background:

• Advance care planning (ACP) is crucial for patient autonomy and quality end-of-life care.
• Understanding racial and ethnic disparities in ACP is essential for equitable healthcare.
• Existing research highlights variations in healthcare utilization across different racial groups.

Purpose of the Study:

• To examine racial and ethnic differences in advance care planning (ACP) among Whites, Blacks, Latinos, and Asians.
• To identify factors contributing to heterogeneity within racial groups regarding ACP.
• To explore racial variations in reasons for not engaging in ACP.

Main Methods:

• Analysis of a national sample of married and cohabiting adults aged 18-64 (N=2,111) from the Knowledge Networks study.
• Utilization of logistic regression models to estimate disparities in ACP rates.
• Inclusion of demographic and socioeconomic factors in statistical models.

Main Results:

• Latinos reported lower rates of discussing preferences and having a living will compared to Whites; educational attainment explained the living will disparity.
• Asians showed lower rates of discussions but higher rates of living wills compared to Whites.
• Racial disparities in ACP were observed primarily among lower socioeconomic status subgroups, with each group reporting distinct barriers to planning.

Conclusions:

• Significant racial and ethnic variations exist in advance care planning prevalence and associated barriers.
• Targeted public health policies are needed to increase ACP engagement across all adult populations.
• Addressing socioeconomic factors and group-specific obstacles is vital for promoting equitable ACP.