Evaluation of equity in hospice care utilization among medicare-enrolled autistic older adults

Background: Better identification of autistic people and increased life expectancy for people with intellectual and developmental disabilities have given rise to an urgent need to better understand end-of-life care in autistic people. We compared hospice utilization of autistic older adults with non-autistic older adults and examined if known inequities in hospice utilization among the general population are exacerbated among autistic older adults.
Methods: We analyzed hospice claims from Medicare, which insures Americans older than 65 years and covers hospice costs. Our sample included 5468 autistic older adults and 10,934 matched population comparison older adults who died during 2013–2021. We used multivariable logistic regression to compare these groups on the odds of any, early, intermediate, and late hospice utilization. We defined early hospice utilization as at least 28 days before death, intermediate as 4–27 days before death, and late as within 3 days of death. Interaction ter..., , # Evaluation of equity in hospice care utilization among medicare-enrolled autistic older adults

Dataset DOI: [10.5061/dryad.p2ngf1w4c](https://doi.org/10.5061/dryad.p2ngf1w4c)

## Project Overview

This project uses Medicare claims data (Parts A & B) to compare hospice care utilization in autistic vs. non-autistic older adults.

Key components:

\- Data Cleaning: Prepares raw Medicare claims data for analysis.

\- Table Generation: Produces descriptive and outcome tables for matched and unmatched cohorts.

\- Matched Cohort Analysis: Uses propensity-score matching (1 autistic : ~2 non-autistic ratio).

\- Unmatched Cohort Analysis: Uses the full sample without matching.

NOTE: This project uses restricted Medicare data that require CMS Data Use Agreement (DUA) approval. The datasets cannot be shared publicly.

## Tools and Dependencies

\- Language: SAS v9.4

\- Required Access: Secure server with Medicare Parts A & B claims files

\- Matching Method: Variable-ratio propensity score m...,