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Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.

ABSTRACT: OBJECTIVE:The objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need. METHODS:Data were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+?years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need. RESULTS:Racial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos. CONCLUSIONS:Expenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright © 2016 John Wiley & Sons, Ltd.

SUBMITTER: Jimenez DE

PROVIDER: S-EPMC7734612 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.

Jimenez Daniel E DE Schmidt Andrew C AC Kim Giyeon G Cook Benjamin Le BL

International journal of geriatric psychiatry 20160701 8

<h4>Objective</h4>The objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need.<h4>Methods</h4>Data were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants age ...[more]

PMID: 27363866

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Project description:ImportancePremature mortality has been observed among people with mental disorders. Comorbid general medical conditions contribute substantially to this reduction in life expectancy.ObjectiveTo provide an analysis of mortality associated with comorbidity between a broad range of mental disorders and general medical conditions.Design, setting, and participantsPopulation-based cohort study of 5 946 800 individuals born in Denmark from 1900 to 2015 and residing in the country at the start of follow-up (January 1, 2000, or their date of birth, whichever occurred later).ExposuresDanish health registers were used to identify people with mental disorders and general medical conditions.Main outcomes and measuresConsidering pairs of mental disorders and general medical conditions, we calculated mortality rate ratios (MRRs) and differences in life expectancy (ie, life-years lost) to assess the association of mortality with both disorders of interest compared with the mental disorder of interest, the general medical condition of interest, and neither disorder of interest.ResultsThe study population comprised 2 961 397 males and 2 985 403 females, with a median (IQR) age of 32.0 years (7.3-52.9) at start of follow-up and 48.9 years (42.5-68.8) at the end. Based on all pairs of comorbid mental disorders and general medical conditions, the mean MRR compared with people without these conditions was 5.90 (median, 4.94; IQR, 3.80-7.30), and the mean reduction of life expectancy compared with the general population was 11.35 years (median, 11.08; range, 5.27-23.53; IQR, 8.22-13.72). The association with general medical condition comorbidity in those with mental disorders varied by general medical condition; for example, the addition of a neurological condition for each of the mental disorders was associated with a mean MRR of 1.22, whereas for cancer, the mean MRR for all mental disorders was 4.07.Conclusions and relevanceIn this study, shorter life expectancy was associated with comorbid mental disorders and general medical conditions compared with the entire population and also when compared with patients who had either mental disorders only or general medical conditions only. Prevention and early detection of comorbidities could reduce premature mortality in patients with mental disorders.

Project description:ObjectivesTo determine whether racial/ethnic disparities in 30/90/180-day mortality, major morbidity, and unplanned readmissions exist among universally insured older adult (≥65 years) emergency general surgery patients; vary by diagnostic category; and can be explained by variations in geography, teaching status, age-cohort, and a hospital's percentage of minority patients.Summary of background dataAs the US population ages and discussions surrounding the optimal method of insurance provision increasingly enter into national debate, longer-term outcomes are of paramount concern. It remains unclear the extent to which insurance changes disparities throughout patients' postacute recovery period among older adults.MethodsSurvival analysis of 2008 to 2014 Medicare data using risk-adjusted Cox proportional-hazards models.ResultsA total of 6,779,649 older adults were included, of whom 82.8% identified as non-Hispanic white (NHW), 9.2% non-Hispanic black (NHB), 5.6% Hispanic, and 1.5% non-Hispanic Asian (NHA). Relative to NHW patients, each group of minority patients was significantly less likely to die [30-day NHB vs NHW hazard ratio (95% confidence interval): 0.88 (0.86-0.89)]. Differences became less apparent as outcomes approached 180 days [180-day NHB vs NHW: 1.00 (0.98-1.02)]. For major morbidity and unplanned readmission, differences among NHW, Hispanic, and NHA patients were comparable. NHB patients did consistently worse. Efforts to explain the occurrence found similar trends across diagnostic categories, but significant differences in disparities attributable to geography and the other included factors that combined accounted for up to 50% of readmission differences between racial/ethnic groups.ConclusionThe study found an inversion of racial/ethnic mortality differences and mitigation of non-NHB morbidity/readmission differences among universally insured older adults that decreased with time. Persistent disparities among nonagenarian patients and hospitals managing a regionally large share of minority patients warrant particular concern.

Project description:BACKGROUND:There exist racial and ethnic disparities in the prevalence of chronic medical illnesses. However, it is unclear if the disparities arise from patients' self-reported estimates on these diseases and whether there is an association between healthcare utilization and diagnosis. OBJECTIVE:To estimate national racial/ethnic prevalence of undiagnosed hypertension, diabetes, high cholesterol, and kidney disease and identify characteristics associated with undiagnosed diseases. DESIGN:Retrospective analysis of multi-year survey data. PARTICIPANTS:Adults 18 years and older who participated in the National Health and Nutrition Examination Survey during 2011-2014 (n?=?10,403). MAIN OUTCOMES:Undiagnosed hypertension (SBP???140 or DBP???90 on physical examination with no history of hypertension), undiagnosed diabetes (hgba1c???6.5% with no history of diabetes), undiagnosed high cholesterol (LDL???160 mg/dL with no history of high cholesterol), and undiagnosed kidney disease (eGFR???30 with no history of kidney disease). RESULTS:The study sample was categorized into Whites, Blacks, Hispanics, Asians, and Other. After adjusting for sociodemographic characteristics, Asians had increased odds of undiagnosed hypertension (OR?=?1.41 [1.06-1.86]) and diabetes (OR?=?6.16 [3.76-10.08]) compared to Whites. Blacks (OR?=?2.53 [1.71-3.73]) and Hispanics (OR?=?1.88 [1.19-2.99]) had increased odds of undiagnosed diabetes compared to Whites. Multivariate logistic regression analysis indicated that not having any health insurance was associated with increased odds of undiagnosed diabetes and hyperlipidemia (OR?=?1.56 [1.00-2.44] and OR?=?2.08 [1.44-3.00], respectively). A recent healthcare visit was associated with a lower likelihood of having undiagnosed hypertension (OR?=?0.58 [0.41-0.83]) and diabetes (OR?=?0.35 [0.18-0.69]). CONCLUSIONS:In a nationally representative cohort, Asians had higher rates of undiagnosed hypertension and diabetes, and all minorities were more likely to have undiagnosed diabetes compared to Whites. Healthcare utilization was associated with undiagnosed medical conditions. Our study showed that reliance on self-reported data may systemically underestimate the prevalence of chronic illnesses among minorities and further research is needed to understand the significance of healthcare utilization in health outcomes.

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Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.

Publications

Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.

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