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Elderly Asian Americans in traditional fee-for-service Medicare receive fewer needed services than their white counterparts

Elderly Asian Americans enrolled in traditional fee-for-service Medicare receive fewer needed services than their white counterparts, concludes a new study. Agency for Healthcare Research and Quality researchers Ernest Moy, M.D., M.P.H., and Linda G. Greenberg, Ph.D., along with Amanda Borsky of the CNA Corporation, examined the association of race/ethnicity and socioeconomic status (SES) with use of Medicare-covered services by the elderly in a unique database that merged improved race/ethnicity coding and SES indicators at the census block-group level with 2002 Medicare claims data. They examined Asian-white differences in two cancer screening services (colorectal cancer screening and mammography) and three diabetes-related care services (measurement of blood-sugar levels, eye exam, and self-care instructions) in the metropolitan statistical areas (MSAs) with the largest number of elderly Asians in 2000, including Los Angeles, New York City, and Washington, D.C.

Elderly Asians were less likely than elderly whites to receive colorectal cancer screening in eight of nine MSAs and mammography in nine MSAs. Asian-white differences in diabetes care were less consistent. In two of nine MSAs, Asians were less likely than whites to receive physiological testing. Asians were less likely to receive eye exams in three MSAs outside of California. They were less likely to receive self-care instruction in the two East Coast MSAs (New York and Washington, D.C.) but more likely to receive it in the greater Los Angeles Area (LA and Orange County). Outside of the nine MSAs, Asian-white differences were significant across both cancer screening services and all three diabetic services.

These findings are consistent with reports on the prevalence of Asian-white disparities at the national level. These care differences are important, especially considering that cancer is the leading cause and diabetes is the fifth leading cause of death among Asians. These findings go beyond previous work by demonstrating disparities at the MSA and census tract levels and after stratifying for SES. Local leaders could use this information to set priorities and allocate resources to address specific care disparities in their communities.

More details are in "Community variation: Disparities in health care quality between Asian and white Medicare beneficiaries," by Drs. Moy and Greenberg and Ms. Borsky, in the March/April 2008 Health Affairs 27(2), pp. 538-549.

Reprints (AHRQ Publication No. 08-R064) are available from the AHRQ Publications Clearinghouse.

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