Wealth Disparities in End-of-Life Experiences Among Older Adults in the US (RP306)

Outcomes 1. Participants will be able to understand the associations between wealth and end-of-life symptom prevalence.2. Participants will be able to evaluate how hospice or Medicaid enrollment modifies the impact of wealth on end-of-life symptoms. Key Message This study found wealth-related disparities in the end-of-life experiences of older adults, with lower wealth linked to a higher likelihood of experiencing 6+ end-of-life symptoms. Medicaid enrollment seems to mitigate this disparity, suggesting certain programs can reduce these differences. Importance Prior research examined health disparities in end-of-life (EOL) based on race, ethnicity and college education. This study examines wealth-related disparities in EOL experience among older adults. Objective(s) Our study aims to: (1) Assess EOL symptom prevalence and associations with wealth; (2) Determine if wealth's effect on EOL symptoms is modified by hospice or Medicaid enrollment. Scientific Methods Utilized The study included 9,509 Health and Retirement Study (HRS) participants who died between 2000 and 2020 at age 65+. Wealth was measured by RAND household net worth variable at the last core interview before death4,5, categorized into bottom quartile, two middle quartiles, and top quartile. End-of-life symptoms, reported by proxies at the exit interview, included 10 symptoms. Our primary outcome was a binary variable, indicating presence of 6+ EOL symptoms. Results The mean age at death was 81 (SD 9); 55% women, 83% White, and 15% college graduates. Overall, 28% of descendants experienced 6+ EOL symptoms. Those with low wealth had higher likelihood of 6+ EOL symptoms compared to middle or high wealth groups (36% vs. 28% vs. 23%, p< 0.001). These differences persisted after adjusting for age, gender, marital status, race or ethnicity, and college education (low-middle wealth: aOR=0.69 (CI: 0.60-0.78); low-high wealth: aOR=0.56 (CI: 0.47-0.65)). There was no significant difference in the effect of wealth among those enrolled in hospice. Medicaid enrollment seemed to diminish the difference between low and middle wealth groups (not in Medicaid: aOR=0.74 (CI: 0.59-0.95); in Medicaid: aOR=0.90 (CI: 0.71-1.12), p for interaction=0.133). Conclusion(s) Lower wealth at the end of life is associated with worse EOL experience. However, enrollment in Medicaid decreases the difference between low and middle wealth groups. Impact Our findings suggest that Medicaid may alleviate wealth-related end-of-life differences. Further studies are needed to determine if the wealth directly impacts EOL outcomes, or if its effects are mediated by functional decline. Keywords Under served, under resourced populations/Models of palliative/hospice care delivery