Linking individual medicare health claims data with work-life claims and other administrative data.

Elizabeth Mokyr Horner,Mark R Cullen

doi:10.1186/s12889-015-2329-6

Abstract

BackgroundResearchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals’ health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers’ administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health.MethodsMedicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996–2008) who transitioned onto Medicare between 2001–2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims.ResultsChronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65.ConclusionsCombining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health.

Highlights

Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals’ health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives
This type of integration will be valuable to researchers trying to understand how health and risk trajectories emerge, investigating health outcomes of retirement, or comparing how policies and programs can alter the timing of retirement to improve long-term health outcomes
The data on employment-based claims files are often censored at age 65, when Medicare becomes primary for individuals who are not otherwise insured, or earlier for individuals who leave their workplaces

Summary

Introduction

Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals’ health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers’ administrative data and private, employment-based health claims with Medicare data. Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data [10,11,12,13] These Medicare claims data subject to less selection bias, but include no direct information. The current paper provides a proof-of-concept for merging employers’ administrative data and private, employment-based health claims with Medicare data, using a sample of former manufacturing workers from an industrial cohort as a test case. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses for such linked data

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