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Disparities/Minority Health

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Fewer visits to the doctor contribute to the higher mortality rates among black Medicare patients in Tennessee

Elderly black Medicare patients in Tennessee make fewer physician visits than their white counterparts, which significantly contributes to their higher mortality rates, concludes a study supported by the Agency for Healthcare Research and Quality (HS11640). However, the study was not able to determine why black elders avoid primary care.

The researchers examined 5 years of health service use data from Medicare physician billing records and 6.3 years of mortality followup data from the Medicare enrollment database to assess physician-diagnosed health problems (morbidity), health care use, and mortality among 665,887 Tennessee Medicare beneficiaries. They developed models to examine the effects of race, socioeconomic status, morbidity, and physician service use on mortality.

Overall, between 1996 and 2002, 38 percent of blacks died compared to 32 percent of whites, a disparity that resulted in 4,164 excess deaths of black elderly people in Tennessee. These excess deaths were largely attributable to race difference in physician visits. Black elders made an average of 7.5 fewer trips to the doctor than white elders during the study period (31.8 vs. 39.3 visits). However, the Medicare cost for fewer black physician visits was the same as the more numerous white physician visits ($902.2 vs. $903.5). This suggests that black patient physician visits were more often in response to serious illnesses that required greater physician attention (and cost).

Decreased use of primary care may also have contributed to the greater number of trips that black elders made to emergency rooms as compared to white elders (average 2.55 vs. 2.06 trips). For example, blacks who suffered from both diabetes and stroke made nearly 14 fewer visits to the doctor over a 5-year period than whites with both conditions. Controlling for health service use eliminated the racial difference in mortality rates for a wide range of conditions.

More details are in "Explaining race differences in mortality among the Tennessee Medicare elderly: The role of physician services," by Darren E. Sherkat, Ph.D., Barbara S. Kilbourne, Ph.D., Van A. Cain, M.A., and others, in the November 2005 Journal of Health Care for the Poor and Underserved 16, pp. 50-63.

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