ABSTRACT
1. Understand demographic factors associated with advance directive (AD) completion. 2. Identify racial/ethnic groups with lower AD completion rates. Previous research has found lower AD completion by Black and Latinx adults. However, most studies were conducted prior to COVID-19 and included patients with different types of insurance coverage. To identify racial/ethnic differences in percentages of middle-aged and older adults in a large US health plan who report having an AD. We analyzed self-reported data for 6,719 adults aged 45 to 90 years who completed the self-administered 2020 Kaiser Permanente Northern California (KPNC) Member Health Survey, which included a question about having an AD. Using data weighted to the 2019 KPNC membership, we estimated AD prevalence for white, Black, Latinx, and Asian American/Pacific Islander (AAPI) adults aged 45 to 64 years, 65 to 74 years, and 75 to 90 years. We used modified log Poisson regression to produce AD prevalence ratios (aPR) comparing Black, Latinx, and AAPI to white adults within ages 45 to 64 years and 65to 90 years adjusted for age, sex, education, relationship status, and overall health rating. Overall, white adults (56.1%) were significantly more likely to report having an AD than AAPI (35.3%), Black (34.4%), and Latinx (29.0%) adults. Compared to white adults, AD prevalence was lower among AAPI (aPR 0.69, CI 0.58-0.82), Black (aPR 0.71, CI 0.52-0.97), and Latinx (aPR 0.56, CI 0.42-0.73) adults ages 45 to 64 years and among AAPI (aPR 0.75, CI 0.69-0.81), Black (aPR 0.82, CI 0.73-0.92), and Latinx (aPR 0.82, CI 0.74-0.92) adults ages 65 to 90 years. Within both age groups, AD prevalence was higher among adults with a college degree and in a committed relationship, after controlling for age, sex, race/ethnicity, and overall health rating. Despite increased public awareness and life-care planning programs, racial/ethnic disparities persist in AD completion. The largest racial/ethnic gaps are seen in middle-aged adults. Further research is needed to develop effective, culturally humble approaches to increasing AD completion across all racial/ethnic groups. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Introduction Information about demographic differences in social risks, needs, and attitudes toward social health screening in non-highly vulnerable adult populations is lacking. Methods The authors analyzed data for 2869 Kaiser Permanente Northern California non-Medicaid-covered members aged 35 to 85 who responded to a 2021 English-only mailed/online survey. The survey covered 7 social risk and 11 social needs domains and attitudes toward social health screening. The authors used data weighted to the Kaiser Permanente Northern California membership to estimate prevalence of risks, needs, and screening receptivity in the overall population, by race/ethnicity (White, Black, Latinx, Asian American/Pacific Islander) and age (35-65 years old, 66-85 years old). Multivariable regression was used to evaluate differences between groups. Results Overall, 26% of adults were financially strained, 12% food insecure, 12% housing insecure, and 5% transportation insecure. Additionally, 7%, 8%, and 17% had difficulty paying for utilities, medical expenses, and dental care, respectively. Over 40% of adults wanted help with ≥ 1 social need. Dental care, vision/hearing care, paying for medical expenses and utilities, and managing debt/credit card repayment surpassed food, housing, and transportation needs. Prevalence of social risks and needs was generally higher among middle-aged versus older and Black and Latinx versus White adults. Among the 70% of adults receptive to screening, 85% were willing to complete a questionnaire and 40% were willing to have staff ask questions; 18% did not want to be screened. Conclusion When implementing social health screening in diverse patient populations, the prevalence of social risks and needs, as well as the acceptability of social health screening and screening modalities, will vary among demographic subgroups.