Ng Judy H, Bierman Arlene S, Elliott Marc N, Wilson Rachel L, Xia Chengfei, Scholle Sarah Hudson
The National Committee for Quality Assurance, 1100 13th St, NW, Ste 1000, Washington, DC 20005. E-mail:
Am J Manag Care. 2014 Mar;20(3):239-48.
This study examined physical and mental health, health symptoms, sensory and functional limitations, risk factors, and multimorbidity among older Medicare managed care members to assess disparities associated with race/ethnicity.
We used data on 236,289 older adults from 208 Medicare plans who completed the 2012 Medicare Health Outcomes Survey to compare 14 health indicators across non-Hispanic whites, blacks, American Indians/Alaskan Natives, Asians, Native Hawaiians/Pacific Islanders, multiracial individuals, and Hispanics. Logistic regression models that clustered on the plan estimated the risk of indicators of adverse health and functional status.
Even after controlling for key patient sociodemographic factors, race/ethnicity was significantly associated with most adverse health indicators. Except for Asians, all racial/ethnic minority groups were significantly more likely than whites to report poor mental health status, presence of most health symptoms, sensory limitations, and activities-of-daily-living disability. Important differences were observed across racial and ethnic groups.
Despite some exceptions, elders of racial/ethnic minority background are generally at higher risk than non-Hispanic whites for a broad range of adverse health and functional outcomes that are not routinely assessed. Limitations include bias related to self-reported data and respondent recall. Future research should consider ethnic subgroup variations; employing newer techniques to improve estimates for smaller groups; and prioritizing and identifying opportunities for care improvement of diverse enrollee groups by considering specific needs. To improve the health status of the elderly, service delivery targeting the needs of specific population groups, coupled with culturally appropriate care for racial/ ethnic minorities, should also be considered.
本研究调查了老年医疗保险管理式医疗成员的身心健康、健康症状、感官和功能限制、风险因素以及多种疾病,以评估与种族/族裔相关的差异。
我们使用了来自208个医疗保险计划的236,289名老年人的数据,这些老年人完成了2012年医疗保险健康结果调查,以比较非西班牙裔白人、黑人、美国印第安人/阿拉斯加原住民、亚洲人、夏威夷原住民/太平洋岛民、多种族个体和西班牙裔之间的14项健康指标。在计划层面进行聚类的逻辑回归模型估计了不良健康和功能状态指标的风险。
即使在控制了关键的患者社会人口学因素之后,种族/族裔仍与大多数不良健康指标显著相关。除亚洲人外,所有种族/族裔少数群体报告心理健康状况不佳、大多数健康症状的存在、感官限制和日常生活活动残疾的可能性均显著高于白人。不同种族和族裔群体之间观察到了重要差异。
尽管存在一些例外情况,但种族/族裔少数群体的老年人通常比非西班牙裔白人面临更广泛的不良健康和功能后果的风险,而这些后果并未得到常规评估。局限性包括与自我报告数据和受访者回忆相关的偏差。未来的研究应考虑种族亚组差异;采用更新技术以改进对较小群体的估计;并通过考虑特定需求,优先确定并找出改善不同参保人群护理的机会。为改善老年人的健康状况,还应考虑针对特定人群需求的服务提供,以及对种族/族裔少数群体的文化适宜护理。