Effects of race and income on mortality and use of services among Medicare beneficiaries

Citation: Gornick, Marian E., et al. (1996) Effects of race and income on mortality and use of services among Medicare beneficiaries. New England Journal of Medicine (Volume 335) (RSS)
Internet Archive Scholar (search for fulltext): Effects of race and income on mortality and use of services among Medicare beneficiaries
Tagged: mortality (RSS), Medicare (RSS), race (RSS), income (RSS)

Summary

Notes: Authors use a sample of Medicare recipients to look at differences in mortality and use of Medicare services between blacks and whites. They conclude that there is a race effect: blacks have higher mortality and use services less than whites. This is in contrast to Rogers (1992) who found no race effect after controlling for income. However, Gornick and colleagues did not have a direct measure of income for individuals in the study. They also did not directly measure access to health care (the supply end). Miguel's summary: There are wide disparities between blacks and whites in the use of many Medicare services. Gornick et al. studied the effects of race and income on mortality and use of services. They linked 1990 census data on median income according to ZIP code with 1993 Medicare administrative data for 26.3 million beneficiaries 65 years of age or older (24.2 million whites and 2.1 million blacks). They calculated age-adjusted mortality rates and age- and sex-adjusted rates of various diagnoses and procedures according to race and income and computed black-white ratios. The 1993 Medicare Current Beneficiary Survey was used to validate the results and determine rates of immunization against influenza. Gornick et al. found that for mortality rates, the black-white ratios were 1.19 for men and 1.16 for women (p<0.001 for both). For hospital discharges (meaning who had been in the hospital more often), the ratio was 1.14 (p<0.001), and for visits to physicians for ambulatory care, it was 0.89 (p<0.001). Therefore, blacks have higher mortality rates and are more likely to be in the hospital, but visit the doctor less perhaps indicating that they receive less preventive care. For every 100 women, there were 26.0 mammograms among whites and 17.1 mammograms among blacks. As compared with mammography rates in the respective most affluent group, rates in the least affluent group were 33 % lower among whites and 22% lower among blacks. The black-white ratio was 2.45 for bilateral orchietomy (removal of testicle(s) I looked it up!) and 3.64 for amputations for all or part of the lower limb (p<0.001 for both). Even though black rates of disease associated with these procedures were higher than white rates, they were not high enough to completely account for the elevated rates of these procedures. Again, these procedures are more drastic than other possible therapies and are more likely to occur in more advanced stages of the disease indicating that blacks may have received less preventive care and later diagnoses of the malady. For every 1000 beneficiaries, there were 515 influenza immunizations among whites and 313 among blacks. As compared with immunization rates in the respective most affluent group, rates in the least affluent group were 26% lower among whites and 39% lower among blacks. Adjusting the mortality and utilization rates for income generally reduced the racial differences, but the effect was relatively small. Gornick et al. conclude that race and income have substantial effects on mortality and use of services among Medicare beneficiaries. Medicare coverage alone is not sufficient to promote effective patterns of use by all beneficiaries.