Disparities in receipt of recommended care among younger versus older medicare beneficiaries: a cohort study

BMC Health Services Research

Hillary R. Bogner¹  Sean Hennessy¹  Jibby E. Kurichi¹  Dawei Xie¹  Pui L. Kwong¹  Ling Na¹  Liliana E. Pezzin²  Steven M. Asch³  Joel E. Streim⁴ 

[1] Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania;Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin;Division of General Medical Disciplines, Stanford University School of Medicine;Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania;

关键词: Medicare;    Younger beneficiaries;    Health disparity;    Recommended care;    Quality of care;   

DOI  :  10.1186/s12913-017-2168-5

来源: DOAJ

【 摘 要 】

Abstract 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.

【 授权许可】

Unknown