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Elderly women with the fewest resources to negotiate the health care system have the highest burden of illness

Many older women suffer from chronic illnesses, or have multiple medical problems, functional impairments, or disabilities. Data from the 1999 Medicare Health Outcomes Survey (MHOS) highlight the paradox that elderly women who are least able to negotiate the health care system have the highest burden of illness, according to a recent study by Arlene S. Bierman, M.D., M.S., and Carolyn M. Clancy, M.D., of the Agency for Healthcare Research and Quality's Center for Outcomes and Effectiveness Research. Understanding and targeting the factors that lead to these differences in illness burden may serve to reduce health disparities among older women.

The survey data were collected for a new quality measure in HEDIS (Health Plan Employer Data and Information Set) to assess functional outcomes in Medicare+Choice plans. The Medicare Health Outcomes Survey (MHOS) asks managed care plans that serve Medicare beneficiaries to report their members' ability to function, multiple symptoms, diagnoses, and sociodemographic characteristics.

Researchers presented data from 91,314 community-dwelling women who responded to the survey that illustrate the magnitude of health disparities in this population. For example, one-fifth of elderly women enrolled in Medicare+Choice plans had annual incomes of less than $10,000 and were more than twice as likely to report fair or poor health than women with annual household incomes greater than $50,000. Nearly one-third of women did not graduate from high school (about half of black, Hispanic, and American Indian women), and 12 percent had less than an 8th grade education. The latter group were nearly three times more likely to report fair or poor health than women who were college graduates.

Over half (52 percent) of women surveyed suffered from three or more chronic conditions. However, women with low income, less education, and minority group status were significantly more likely to suffer from chronic diseases and limited ability to function than other women.

The researchers note that although clinicians play a central role in improving care for older women, health system changes will be required. They suggest actions that may be undertaken by practitioners to improve access to and quality of care for older women. These include referring patients to Federal and State programs that provide medication support for low-income elderly people and implementing clinical interventions that reduce the risk of stroke and hip fractures as well as the progressive loss of function due to common chronic conditions. Health system redesign should enhance chronic disease self-management and community support and identify the resources needed to improve the functioning of older women.

More details are in "Health disparities among older women: Identifying opportunities to improve quality of care and optimize functional health outcomes," by Drs. Bierman and Clancy, in the fall 2001 Journal of the American Medical Women's Association 56, pp. 155-160.

Reprints (AHRQ Publication No. 02-R023) are available from the AHRQ Publications Clearinghouse.

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