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Abstract
BackgroundAlthough health disparities have been documented between Medicare beneficiaries based on age (<65 years vs. older age groups), underuse of recommended medical care in younger beneficiaries has not been thoroughly investigated. In this study, we aim to identify and characterize vulnerabilities of the younger Medicare age group (aged <65 years) in relation to older age groups (aged 65–74 years and ≥75 years) and to explore age group as a determinant of use of recommended care among Medicare beneficiaries.MethodsWe conducted a cohort study of community-dwelling Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey between 2001 and 2008 (N = 30,117). Age group characteristics were compared using cross-sectional data at baseline. During follow-up, we assessed the association between age and receipt of recommended care on 38 recommended care indicators, adjusting for sociodemographic and clinical characteristics. Follow-up periods differed by component indicator.ResultsAt baseline, a higher proportion of younger beneficiaries experienced social disadvantage, disability and certain morbidities than older age groups. During follow-up, younger beneficiaries were significantly less likely to receive overall recommended care compared to those 65–74 years of age (adjusted odds ratio and 95% confidence interval: 0.75, 0.70–0.80). In addition, male gender, non-Hispanic black race, less than high school education, living alone, with children or with others, psychiatric disorders and higher activity limitation stages were all associated with underuse of recommended care.ConclusionsYounger Medicare beneficiary status appears to be an independent risk factor for underuse of appropriate care. Support to ameliorate disparities in different social and health aspects may be warranted.
Highlights
Health disparities have been documented between Medicare beneficiaries based on age (
It is expected that younger beneficiary status is associated with health disparity due to Medicare enrollment criteria, younger beneficiaries demonstrated largely unmet health care needs
Compared to the older groups, younger beneficiaries were more likely to be nonHispanic black (19% vs. 9% and 7%) and Hispanic (11% vs. 8% and 6%), to live with others (24% vs. 5% and 4%), and to be dually-enrolled in Medicaid (44% vs. 11% and 12%)
Summary
Health disparities have been documented between Medicare beneficiaries based on age (
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