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Greater access to physician services may narrow mortality differences among the black and white elderly

Less access to physician services among the black elderly explains most of the racial differences in mortality compared with the white elderly, concludes a new study. These results held, even after accounting for racial differences in diagnosed medical conditions, socioeconomic status, and use of other health care services.

Black elderly people in Tennessee made more trips to the emergency room than white elderly people (2.6 vs. 2.1 visits), and had more hospitalizations (1.34 vs 1.25). Whites averaged 7.5 more trips to the physician than blacks during the 5 years of observation. However, adding controls for physician service use reduced the risk of mortality for several medical conditions from 7.53 to 1 for blacks.

Dissatisfaction with physician services and poor treatment likely contribute to blacks' tendency to avoid primary care. However, primary care doctors are essential for monitoring diabetes and hypertension, and for providing referrals for screening for cancer and other conditions. Delaying treatment until emergency services are required may increase mortality rates for the black elderly, explain the researchers.

They found that elderly blacks were diagnosed with more conditions than whites, especially certain conditions. Blacks had 52 percent higher likelihood of a diabetes diagnosis than whites and a 17 percent higher risk of a mental illness diagnosis. Blacks also were more likely to be diagnosed with colorectal cancer and had a 25 percent higher risk of prostate cancer.

The researchers used longitudinal data from the Center for Medicare & Medicaid Services Physician billing data and Medicare Enrollment Database to assess physician-diagnosed conditions, health service use, and mortality among the 665,887 Medicare beneficiaries in Tennessee. The study was supported by the Agency for Healthcare Research and Quality (HS11640).

See "The impact of health service use on racial differences in mortality among the elderly," by Darren E. Sherkat, Ph.D., Barbara S. Kilbourne, Ph.D., Van A. Cain, M.A., and others, in the May 2007 Research on Aging 29(3), pp. 207-224.

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