Abstract
Well-documented racial disparities in advance care planning (ACP) raise concerns regarding end-of-life care received by African Americans (AA). Although no clear reasons for disparities have been identified, religiosity is one commonly proposed explanation. Health and Retirement Study data (N=6,861) were analyzed to examine how religious affiliation, behaviors, and beliefs were associated with written and verbal ACP and to determine if religiosity explained ACP disparities between older Whites and AAs. The odds of advance directive completion were twice as high for Whites after controlling for demographic and health-related covariates (OR=2.51). Similar results were shown for advance care discussion (OR=2.42). More frequent religious service attendance was associated with higher odds of advance directive completion (OR=1.12), and more frequent prayer was positively related to verbal ACP (OR=1.08). Importance of religion was negatively associated with advance directive completion (OR=.87). Compared to those with no religious affiliation, Catholics (OR=.68) and Protestants (OR=.73) were less likely to engage in advance care discussion. In intragroup analyses, religious service attendance was positively associated with advance directive completion for both Whites and AAs. Whites who were Catholic and AAs who were Protestant were less likely to discuss treatment preferences compared to those with no religious affiliation. For White participants only, importance of religion exhibited a negative relationship with written ACP, whereas more frequent prayer was associated with higher odds of both written and verbal ACP. Although religiosity did not explain race disparities, distinct aspects of religiosity influenced ACP both negatively and positively, and these effects varied by race.