Who Cares at the End of Life? Unmet care needs across 32 Countries

Despite the growing global demand for end-of-life care resulting from rapid social transformations, significant gaps exist in cross-national research examining unmet end-of-life care needs. Using harmonized end-of-life survey data (2010-2021) from the United States, 28 European countries, South Korea, China, and Mexico, here we show that the United States, Europe, and South Korea exhibited higher overall unmet end-of-life care needs than China and Mexico, where limited formal care provision was compensated with high levels of informal care. Death at institutions was associated with lower overall unmet end-of-life care needs in the United States and South Korea, with Mexico presenting an exception. Similarly, urban areas in Europe and South Korea exhibited lower unmet formal end-of-life care needs compared to rural areas. Among married individuals, only Mexico exhibited significantly lower unmet overall end-of-life care needs compared to unmarried individuals. Having children was consistently linked to lower unmet informal end-of-life care needs across the United States, Europe, and South Korea. Our findings highlight the complex interplay between care systems and family demographic structures in shaping end-of-life care access, and underscore the need for tailored policy approaches that strengthen both formal and informal care systems while addressing sociodemographic disparities in care access.