Regional variations of racial disparities in advance care planning of older adults

Abstract

ABSTRACT Given the lack of research on geographic variations in advance care planning (ACP) engagement, this study examined whether there were 1) regional variations in engagement in ACP and 2) racial and ethnic differences in ACP by regions of the United States. The sample included 2,015 Medicare beneficiaries in the U.S. from the 2012 National Health and Aging Trends Study that asked respondents about ACP engagement (i.e., discussed end-of-life treatments, had a durable power of attorney for health care, or completed a living will). Results from logistic regression analysis showed that older adults living in the West (OR = 1.66, p = .003) and the Midwest (OR = 1.39, p = .032) were more likely to engage in ACP than those living in the South. Furthermore, logistic regression analyses that examined racial and ethnic differences by region revealed that Blacks were less likely to be engaged in ACP than Whites in the Northeast, Midwest, and South. Hispanics were less likely to participate in ACP than Whites in the West and the Northeast. The findings provide an insight into disparities in ACP in different regions in the U.S., suggesting target areas for interventions to improve engagement in ACP among non-dominant racial and ethnic populations.