Amresh D. Hanchate, PhD¹, Yinong Young-Xu, ScD, MS¹, Michael A Posner, MS², Ezekiel Emanuel, MD, PhD³, Arlene Ash, PhD⁴, and Veeran-Anne Singh, MPH⁵. (1) General Internal Medicine, Boston University School of Medicine, 720 Harrison Avenue, DOB Suite 1108, Boston, MA 02118, 617 638 8889, hanchate@bu.edu, (2) Department of Biostatistics, Boston University, 720 Harrison Ave #1108, Boston, MA 02118, (3) Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Room 1C118, Bethesda, MD 20892, (4) Health Care Research Unit, Boston University School of Medicine, 720 Harrison Ave., Suite 1108, Boston, MA 02118, (5) Randomized Controlled Trials Unit, Canadian Institutes of Health Research, 160 Elgin Street, 9th Floor, Ottawa, QC K1A 0W9, Canada

Background: Many studies show that African-Americans and Hispanics receive fewer health care services and have lower health care costs. However in our previous studies in Massachusetts and California, we found African-American and Hispanic Medicare beneficiaries to have significantly higher costs in the last year of life. Objective: Estimate differences by race, ethnicity and age in end-of-life health care costs in a large sample of Medicare decedents. Contrast these with data for Medicare non-decedents. Methods: We obtained a nationally representative stratified sample of one million Medicare enrollees aged 66+ in 2001; 241,655 of who had died in 2001. We included all Hispanic (30K) and Other (42K) decedents in 2001, and a sample of 85K each of White and African-American decedents. We excluded those not in Medicare Fee for Service and those in the End Stage Renal Disease program. Total Medicare costs per person by type of care were calculated for 365 days prior to death for each decedent and from July 1, 2000 to June 30, 2001 for non-decedents. Results: Demographic groups differ in how they use health services. For example, while physician costs for Whites were $4,439, they were significantly higher among African-Americans ($4,793), Hispanics ($5,293) and Others ($4,782). But a weaker, opposite trend holds for non-decedents. Hospital use also differs by demographics, but the patterns are different.

Learning Objectives:

• Ability to describe differences in how medical care is used at the end of life by race, ethnicity and age.

Keywords: Health Disparities, Medicare

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.