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Am J Hosp Palliat Care. 2018 Oct;35(10):1323-1329. doi: 10.1177/1049909118773989. Epub 2018 May 3.

Relationship Between Expectation of Death and Location of Death Varies by Race/Ethnicity.

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1 University of Virginia School of Nursing, Charlottesville, VA, USA.
2 Geriatrics, Extended and Palliative Care, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
3 Division of Geriatrics, University of California, San Francisco, CA, USA.



Older black and Latino Americans are more likely than white Americans to die in the hospital. Whether ethnic differences in expectation of death account for this disparity is unknown.


To determine whether surviving family members' expectation of death has a differential association with site of death according to race or ethnicity.


We conducted an analysis of decedents from the Health and Retirement Study, a nationally representative study of US older adults. Telephone surveys were conducted with family members for 5979 decedents (decedents were 55% were women, 85% white, 9% black, and 6% Latino). The outcome of interest was death in the hospital; the predictor variable was race/ethnicity, and the intervening variable was expectation of death. Covariates included sociodemographics (gender, age, household net worth, educational attainment level, religion) and health factors (chronic conditions, symptoms, health-care utilization).


Decedents' race/ethnicity was statistically related to the expectation of death and death in the hospital. When death was not expected, whites and Latinos were more likely to die in the hospital than when death was expected (49% vs 29% for whites and 55% vs 37% for Latinos; P < .001). There was no difference in site of death according to family's expectation of death among blacks.


Expectation of death did not fully account for site of death and played a greater role among whites and Latinos than among black Americans. Discussing prognosis by itself is unlikely to address ethnic disparities. Other factors appear to play an important role as well.


disparities; health-care utilization; older adults; prognosis awareness

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