Objectives: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States.Method: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates.Results: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased.Conclusion: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.

中文翻译：

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慢性健康状况的数量与预先护理计划之间的关联因种族/民族而异。

目标：尽管已经有全国共识，需要提高所有成年人的提前护理计划（ACP）比率，但始终观察到ACP的种族/种族差异。这项研究调查了美国中年和老年人在ACP上种族/族裔差异和慢性健康状况的交集。方法：2014年健康与退休研究浪潮中来自8,926名成年人的回应被纳入研究多层次分层逻辑回归分析和广义线性混合模型来预测ACP，该ACP专注于分配持久性医疗保健授权书（DPOAHC）和调整协变量后的书面生活意愿。结果：我们发现慢性病患者人数之间存在显着的正相关关系健康状况和ACP。与非西班牙裔白人/高加索人相比，非西班牙裔黑人/非裔美国人和西班牙裔美国人从事ACP的可能性较小。种族/族裔差异甚至使他们无法维持生计。与非西班牙裔白人/高加索人相比，通过分配DPOAHC并拥有生活意愿，慢性病对西班牙裔的影响要大得多于非西班牙裔白人/高加索人。没有慢性健康状况的西班牙裔美国人中ACP的最初差异随着慢性健康状况的增加而减少。结论：我们的研究结果表明，更多的慢性健康状况增加了西班牙裔人完成ACP文件的可能性。这些ACP差异应向研究人员，政策制定者和医疗保健专业人员强调，以减少ACP中明显的种族/种族差异。