Does Religiosity Account for Lower Rates of Advance Care Planning by Older African Americans?

Abstract

Advance care planning (ACP) is associated with higher quality care at the end of life and increased odds of receiving hospice care and of dying at home. Older African Americans are less likely to complete advance directives (ADs) or discuss life-sustaining treatment preferences. This study examined whether religiosity accounts for race disparities. Analyses were conducted with Health and Retirement Study data (1,180 African Americans, 5,681 Whites). Two forms of ACP were regressed on race, five measures of religiosity, and demographic, health, and health care covariates. Whites were twice as likely to engage in ACP. Including religiosity predictors did not close these gaps. Frequency of service attendance was positively associated with AD completion for both White and African American participants. Relationships between religious affiliation and advance care discussion varied by race. For White participants only, more frequent prayer was associated with higher odds of advance care discussion. Although religiosity is often proposed as a reason for low rates of ACP among African Americans, religiosity measures did not explain race differences. Distinct aspects of religiosity were associated with ACP both negatively and positively, and these relationships varied by type of ACP and by race.