Amano Takashi, Inoue Megumi, Dixit Sharmilee, Tarafder Ayush
School of Arts and Sciences (TA), Rutgers University - Newark, Newark, NJ.
Department of Social Work (MI), George Mason University, Fairfax, VA.
Am J Geriatr Psychiatry. 2025 Nov;33(11):1159-1170. doi: 10.1016/j.jagp.2025.06.006. Epub 2025 Jun 12.
This study aims to investigate racial/ethnic variations in advance care planning (ACP) among people with Alzheimer's disease and related dementias (ADRD) and identify race/ethnicity-specific correlates of ACP.
The study used data from four waves of the Health and Retirement Study (HRS, 2012-2018). We included 5,420 observations with dementia, which was estimated using the machine-learning based Gianattasio-Power algorithm. Five types of engagement in ACP were measured: durable power of attorney, living will, future treatment discussion, limiting medical treatment, and number of ACP engaged. Besides ethnoracial identity, potential correlates of ACP were selected based on the literature. Regression analyses with subgroup analyses by race/ethnicity were performed.
Ethnoracial identity was significantly associated with the likelihood of ACP engagement. The association between ethnoracial identity and the number of ACP engagement was significant after adjusting for covariates. Non-Hispanic Black (Risk Ratio [RR] = 0.670, 95% Confidence Interval [CI] = [0.607, 0.740]) and Hispanic (RR= 0.597, 95% CI = [0.518, 0.688]) individuals with ADRD engaged in fewer ACP than non-Hispanic White counterparts. Factors such as gender, marital status, household wealth and income, number of ADL difficulty, number of health conditions, self-rated health, and nursing home residency were differentially associated with the number of ACP engagement among three ethnoracial groups.
The prevalence of engagement in ACP varies across ethnoracial groups. Non-Hispanic Black and Hispanic individuals are less likely to engage in various aspects of ACP than their non-Hispanic white counterparts. Race/ethnicity-specific correlates of ACP should be considered to develop equitable strategies that promote ACP among diverse populations.
本研究旨在调查阿尔茨海默病及相关痴呆症（ADRD）患者在预先护理计划（ACP）方面的种族/民族差异，并确定与ACP相关的种族/民族特异性因素。
该研究使用了来自健康与退休研究（HRS，2012 - 2018年）四个波次的数据。我们纳入了5420例患有痴呆症的观察对象，痴呆症是使用基于机器学习的贾纳塔西奥 - 鲍尔算法估算的。测量了五种参与ACP的方式：持久授权书、生前遗嘱、未来治疗讨论、限制医疗治疗以及参与ACP的数量。除了种族/民族身份外，还根据文献选择了可能与ACP相关的因素。进行了按种族/民族分组的回归分析及亚组分析。
种族/民族身份与参与ACP的可能性显著相关。在调整协变量后，种族/民族身份与参与ACP的数量之间的关联显著。患有ADRD的非西班牙裔黑人（风险比[RR] = 0.670，95%置信区间[CI] = [0.607, 0.740]）和西班牙裔（RR = 0.597，95% CI = [0.518, 0.688]）个体参与ACP的次数少于非西班牙裔白人。性别、婚姻状况、家庭财富和收入、日常生活活动困难数量、健康状况数量、自评健康状况以及养老院居住情况等因素在三个种族/民族群体中与参与ACP的数量存在不同程度的关联。
参与ACP的比例在不同种族/民族群体中存在差异。非西班牙裔黑人和西班牙裔个体在ACP的各个方面参与的可能性低于非西班牙裔白人。在制定促进不同人群参与ACP的公平策略时，应考虑与ACP相关的种族/民族特异性因素。
