The Intersectional Impact of Race and Gender on Quality of Life At the End of Life

Racial and gender disparities at the end of life have been well-studied in the literature, but few studies have considered the impact of intersectionality on end-of-life outcomes. This study examined the intersectional impact of race and gender on eight indicators of quality of life at the end of life; hospice care, pain, anxiety/depression, dying alone, religious belief discussions, treatment with respect, having decisions made without the patient’s input, and overall care rating.In this study, data were derived from the combined 2013 (Round 3) to 2020 (Round 10) National Health and Aging Trends Study (NHATS). Chi-square tests were used for bivariate analyses, and two multivariate logistic regressions were used to assess the impact of race and gender on quality of life at the end of life. Model 1 included the main effects of race and gender, while Model 2 included the interaction term for race/gender. The interaction models for all dependent variables were significant, except for the “treated with respect” variable. Regarding the gender effects of race, White women and Black women had worse outcomes compared to their male peers. For the race effects of gender, Black men and Black women had worse outcomes compared to their White peers. Black women had the worse outcomes for both race and gender effects, thus confirming the theory of intersectionality. Provider cultural humility training, early intervention, and culturally sensitive patient education may help in mitigating these disparities. Future research should consider primary data collection and include qualitative accounts to guide targeted interventions.