Black and White older adults' end-of-life experiences: does hospice use mitigate racial disparities?

OBJECTIVES: Racial disparities in end-of-life care are well documented, but less is known about how these inequalities shape assessments of death quality. This study examines Black-White differences in two core dimensions of proxy-reported end-of-life experience: perceived death quality and perceived care concordance. We also assess whether hospice care moderates racial differences in death quality outcomes.

METHODS: Data are from the Health and Retirement Study Core and Exit Interviews conducted between January 2018 and September 2023. Our analytic sample included 2,498 decedents (450 Black, 2,048 White). Multivariable ordinary least squares and logistic regression models are used to estimate the associations between race, hospice use, and our two end-of-life experience outcomes.

RESULTS: Proxies for Black decedents reported higher perceived death quality than those for White decedents, despite evidence of greater structural disadvantage. However, perceived care concordance was significantly lower among Black decedents. Hospice care was associated with improved perceived death quality for Black decedents but not for Whites. When accounting for socioeconomic and death experience controls, hospice care did not moderate perceived care concordance.

DISCUSSION: Our findings highlight the importance of considering expectations, context, and reference group comparisons when interpreting subjective end-of-life measures. Expanding equitable access to high-quality hospice care may help reduce persistent racial disparities, but interventions must also address how care is experienced, evaluated, and aligned with individual preferences.