Chronic illnesses affect older black and white patients differently
While many of the same chronic health conditions affect most older adults in the United States, there are racial differences in the extent to which these conditions contribute to death or require advanced care, concludes a new study published in the American Journal of Epidemiology.
A collaborative effort between researchers at Oregon Health & Science University and Yale University, the study dives into survey data of approximately 4,800 federal Medicare beneficiaries between 2011 and 2015. The research team found heart and kidney problems, as well as depression and dementia, were common among the older people surveyed. But when the data was analyzed by race, the researchers found that these conditions affected black and white patients differently.
“Understanding which chronic conditions contribute to more Medicare-funded hospital or skilled nursing care can help policymakers better prepare for the future costs of government-sponsored health insurance,” said the study’s corresponding author, Anna Quiñones, Ph.D.associate professor in the OHSU-PSU School of Public Health and the Department of Family Medicine in the OHSU School of Medicine.
“It’s also about the lives of patients,” Quiñones added. “Understanding which chronic conditions are more common in people with similar histories can help you take preventative action now and reduce the risk of these conditions leading you to need more advanced health care when you’re older.”
Looking at hospitalizations, researchers found that heart disease caused by narrowing of the arteries, heart failure, and kidney disease most commonly affected Medicare beneficiaries. However, the extent to which all three conditions were found in hospitalized patients was higher in black patients. At the same time, while chronic obstructive pulmonary disease and depression were major contributors to hospitalization for white patients, these conditions were not significant factors for hospitalized black patients.
Similar disparities were found when examining data from patients admitted to skilled nursing facilities for post-hospital transitional care. Kidney disease, heart failure, and dementia were the top conditions for all skilled nursing patients, but these conditions were more common among black patients. Meanwhile, two other conditions – depression and heart disease – only contributed significantly to the admission of white patients to skilled nursing facilities.
Researchers continued to find that race played a role when they studied data from patients who eventually died. Kidney disease was almost twice as likely to contribute to death in black patients than white patients. Heart disease and depression were significant factors in death for white patients, but not for black patients.
While the research team focused this study on identifying conditions affecting health outcomes for black and white patients, they suggested potential explanations for why certain disparities exist. For example, knowing that black patients often have more difficulty accessing preventive care, the research team hypothesized that this might explain why certain chronic conditions are more common among hospitalized black patients.
The main limitation of this study is that it only explored differences between blacks and whites, and did not assess ethnicity. After researchers narrowed survey data on Medicare beneficiaries to meet their specific analysis criteria, too few Hispanic patients remained to assess how or if ethnicity plays a role in health conditions. and the results.
Quiñones and his colleagues are currently conducting a similar analysis with a different data source that includes more Hispanic patients, and should also allow them to measure disparities that may be experienced by Hispanic patients.
This work was supported by several grants from the NIH National Institute of Aging
(RF1 AG058545, R01 AG055681, R01AG047891, P30 AG021342, R33 AG045050, P30 AG066508, U01AG032947). The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
REFERENCE: Ana R. Quiñones, Gail J. McAvay, Katherine D. Peak, Brent Vander Wyk, Heather G. Allore, “The Contribution of Chronic Diseases to Hospitalization, Skilled Nursing Setting
Admission, and Death: Variation by Race”, American Journal of Epidemiology, September 13, 2022, https://doi.org/10.1093/aje/kwac143