Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110546

Arlene Ash, PhD¹, Amresh D. Hanchate, PhD², Yinong Young-Xu, ScD, MS², Jennifer Fonda, MA³, and Ezekiel Emanuel, MD, PhD⁴. (1) Health Care Research Unit, Boston University School of Medicine, 720 Harrison Ave., Suite 1108, Boston, MA 02118, 617-638-8030, aash@bu.edu, (2) General Internal Medicine, Boston University School of Medicine, 720 Harrison Avenue, DOB Suite 1108, Boston, MA 02118, (3) Health Care Research Unit, Boston Medical Center, 720 Harrison Ave., Suite 1108, Boston, MA 02118, (4) Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Room 1C118, Bethesda, MD 20892

Background: We previously found that last-year-of-life Medicare expenditures among blacks ($35K), Hispanics ($37K) and Others ($35K) greatly exceeded those among non-Hispanic whites ($28K) in 2001. These estimates are not adjusted for the large geographical differences in expensiveness of care – average last-year-of-life Medicare expenditure was $44K in New York and $21K in Minnesota. Since different racial and ethnic populations may not be geographically distributed the same way, racial differences in expenditures may be over or under estimated.

Objective: To estimate white – non-white differences in last-year-of-life Medicare expenditures after adjusting for geographical differences in Medicare utilization levels.

Methods: We use a nationally representative sample of 163K Medicare decedents (in 2001) aged 66+ who are in Medicare Fee for Service but not in the End Stage Renal Disease program. By design non-whites are over-sampled. We estimated a two-level hierarchical (fixed effects) regression model that gives estimates of expenditures differences between whites and non-whites (blacks, Hispanics, Others) adjusted for county-level average expenditures. We also adjust for gender, age, comorbidity burden and cause of death.

Results: Adjusting for geographical differences in expensiveness leads to large reductions in afore-mentioned white—non-white differences in last-year-of-life Medicare expenditures, suggesting that compared to whites larger proportion of non-whites reside in more expensive counties. White-black difference decreases from $7.4K to $4.3K; further adjusting for comorbidity burden and cause of death reduces the difference to $0.7K. The corresponding three figures for White-Hispanic differences are $8.7K, $5.0K and $1.3K; and for Others they are $6.6K, $2.4K and $0.8K.

Learning Objectives:

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

Keywords: Medicare, End-of-Life Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.