Racial Ethnic Differences in Advance Directive Completion Among Middle-Aged and Older US Adults (Sch455)

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.)