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Low education and income are related to poor health, chronic illness, and depression among Medicare-insured older women

Poorer and less educated elderly women enrolled in Medicare + Choice plans reported poorer health, experienced more chronic illness, and felt depressed or sad more of the time in the past year than their more affluent and educated counterparts, according to an analysis of data from the Medicare Health Outcomes Survey. The survey provided the opportunity to examine the health and functional status of 91,314 elderly community-dwelling women enrolled in Medicare managed care programs in 1999. Race/ethnicity also influenced elderly women's health status, according to Arlene S. Bierman, M.D., M.S., of the Agency for Healthcare Research and Quality.

Women with annual household incomes of less than $10,000 were more than twice as likely to report fair or poor health compared with women whose incomes were more than $50,000 (40 vs. 15 percent). Nearly half of those with an 8th grade education or less said they were in fair or poor health. They were nearly three times more likely to report fair or poor health than college graduates (47 vs. 16 percent). Women with some high school education were more likely to report fair or poor health than high school graduates (38 vs. 26 percent). About one-fifth (21 percent) of women with annual incomes of less than $10,000 reported depressed mood compared with 8 percent of women who had incomes of more than $50,000.

Over half of black, Hispanic/Spanish, and American Indian/Alaska Native elderly women had household incomes less than $20,000, and over half of these women had less than a high school education. More than one-third of Hispanic/Spanish women had an 8th grade education or less. Black women were most likely to report fair or poor health (46 percent) followed by Hispanic/Spanish women (42 percent), and American Indian/Alaska Native women (36 percent). White and Asian/Pacific Islander women were least likely to report fair or poor health (27 and 28 percent, respectively). One in every seven women overall—but one in five black, Hispanic/Spanish, and American Indian/Alaska Native women—reported they were depressed or sad in the past year.

More details are in "Health disparities among older women enrolled in Medicare managed care," by Dr. Bierman, Samuel C. Haffer, Ph.D., and Yi-Ting Hwang, Ph.D., in the summer 2001 Health Care Financing Review 22(4), pp. 187-198.

Reprints (AHRQ Publication No. 02-R006) are available from the AHRQ Publications Clearinghouse.

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