Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA.
School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA.
Gerontologist. 2024 Jan 1;64(1). doi: 10.1093/geront/gnad012.
Research on racial and gender disparities in end-of-life care quality has burgeoned over the past few decades, but few studies have incorporated the theory of intersectionality, which posits that membership in 2 or more vulnerable groups may result in increased hardships across the life span. As such, this study aimed to examine the intersectional effect of race and gender on the quality of care received at the end of life among older adults.
Data were derived from the combined Round 3 to Round 10 of the National Health and Aging Trends Study. For multivariate analyses, 2 logistic regression models were run; Model 1 included the main effects of race and gender and Model 2 included an interaction term for race and gender.
Results revealed that White men were the most likely to have excellent or good care at the end of life, followed by White women, Black men, and Black women, who were the least likely to have excellent or good care at the end of life.
These results point to a significant disadvantage for Black women, who had worse end-of-life care quality than their gender and racial peers. Practice interventions may include cultural humility training and a cultural match between patients and providers. From a policy standpoint, a universal health insurance plan would reduce the gap in end-of-life service access and quality for Black women, who are less likely to have supplemental health care coverage.
在过去几十年中，关于生命末期护理质量的种族和性别差异的研究蓬勃发展，但很少有研究纳入交叉性理论，该理论假设两个或更多弱势群体的成员身份可能会导致整个生命周期的困难增加。因此，本研究旨在检查种族和性别对老年患者生命末期护理质量的交叉影响。
数据来自国家健康与老龄化趋势研究的第 3 轮至第 10 轮的合并数据。对于多变量分析，运行了 2 个逻辑回归模型；模型 1 包括种族和性别的主要效应，模型 2 包括种族和性别之间的交互项。
结果表明，白人男性最有可能在生命末期获得优秀或良好的护理，其次是白人女性、黑人男性和黑人女性，他们最不可能在生命末期获得优秀或良好的护理。
这些结果表明，黑人女性处于明显的劣势地位，她们的生命末期护理质量比其性别和种族的同龄人更差。实践干预措施可能包括文化谦逊培训和患者与提供者之间的文化匹配。从政策角度来看，全民医疗保险计划将减少黑人女性在生命末期服务获取和质量方面的差距，因为她们获得补充医疗保健的可能性较小。
