Disparities in receipt of recommended care among younger versus older medicare beneficiaries: a cohort study. BMC Health Serv Res 2017 Mar 29;17(1):241
Date
03/31/2017Pubmed ID
28356149Pubmed Central ID
PMC5371256DOI
10.1186/s12913-017-2168-5Scopus ID
2-s2.0-85016309313 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
BACKGROUND: Although health disparities have been documented between Medicare beneficiaries based on age (<65 years vs. older age groups), underuse of recommended medical care in younger beneficiaries has not been thoroughly investigated. In this study, we aim to identify and characterize vulnerabilities of the younger Medicare age group (aged <65 years) in relation to older age groups (aged 65-74 years and ≥75 years) and to explore age group as a determinant of use of recommended care among Medicare beneficiaries.
METHODS: We conducted a cohort study of community-dwelling Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey between 2001 and 2008 (N = 30,117). Age group characteristics were compared using cross-sectional data at baseline. During follow-up, we assessed the association between age and receipt of recommended care on 38 recommended care indicators, adjusting for sociodemographic and clinical characteristics. Follow-up periods differed by component indicator.
RESULTS: At baseline, a higher proportion of younger beneficiaries experienced social disadvantage, disability and certain morbidities than older age groups. During follow-up, younger beneficiaries were significantly less likely to receive overall recommended care compared to those 65-74 years of age (adjusted odds ratio and 95% confidence interval: 0.75, 0.70-0.80). In addition, male gender, non-Hispanic black race, less than high school education, living alone, with children or with others, psychiatric disorders and higher activity limitation stages were all associated with underuse of recommended care.
CONCLUSIONS: Younger Medicare beneficiary status appears to be an independent risk factor for underuse of appropriate care. Support to ameliorate disparities in different social and health aspects may be warranted.
Author List
Na L, Streim JE, Pezzin LE, Kurichi JE, Xie D, Bogner HR, Kwong PL, Asch SM, Hennessy SAuthor
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Age FactorsAged
Cohort Studies
Female
Humans
Male
Medicare
Middle Aged
Odds Ratio
Patient Acceptance of Health Care
Quality of Health Care
Risk Factors
United States
