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African-American and Hispanic patients have substantially higher end-of-life costs than White patients, according to the results of a study published in the Archives of Internal Medicine.[1]( "_ednref1")

The cost of end-of-life care contributes significantly to the overall cost of healthcare in the United States. These costs are partially related to the intensity of the care; the more intensive treatments—such as tube feeding and ventilator support—are the most costly.

Choosing end-of-life care is a deeply personal and often difficult decision. An increasing number of patients are signing advanced directives and living wills in order to spare themselves from the more intensive, life-sustaining treatments. However, there are marked differences in populations signing advanced directives. In one study in cancer patients, less than half of African Americans and Hispanics signed advanced directives, whereas 80% of the White populations signed such documents.[2]( "_ednref2")

Cultural, socioeconomic, and religious factors may affect end-of-life decisions. It is generally accepted that racial and ethnic minorities receive fewer medical interventions than Whites during their lifetime; however, less is known about end-of-life care in minority populations.

Researchers from Boston University and the Department of Bioethics of the National Institutes of Health conducted a study to compare end-of-life costs among Whites, African Americans, and Hispanics. They evaluated a random sample of over 150,000 Medicare patients who died in 2001. They found that in the final six months of life, healthcare costs for Whites averaged $20,166 compared with $26,704 for African Americans and $31,702 for Hispanics. They found that approximately half of the increased costs were due to differences in age, sex, cause of death, total morbidity burden, geography, socioeconomic, and hospice differences.

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By additional modeling, they concluded that 85% of observed higher costs for non–Whites was due to greater end-of-life use of the intensive care unit and intensive procedures. For example, African Americans and Hispanics were twice as likely to have a feeding tube placed as their White counterparts.

The researchers concluded: “At life’s end, [African-American] 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.”


[1]( "_edn1") Hanchate A, Kronman AC, Young-Xu Y, et al. Racial and ethnic differences in end-of-life costs. Why do minorities cost more than whites? Archives of Internal Medicine. 2009; 169: 493-501.

[2]( "_edn2") Smith AK, McCarthy EP, Paulk E, et al. Racial and ethnic differences in advance care planning among patient with cancer: Impact of terminal illness acknowledgement religiousness, and treatment preferences. Journal of Clinical Oncology. 2009; 26: 4131-4137.

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