This report discusses disparities in care of baby boom patients with diabetes who become eligible for Medicare. It also examines disparities related to cardiovascular conditions because of their prevalence among older adults and their association with diabetes. Specifically, this report contains 1.) an overarching conceptual model for disparities in midlife adults (45–64) vs. older adults (>65); 2.) key findings from the literature on disparities in health care quality among midlife and older adults, including disparities based on gender, race/ethnicity and socioeconomic factors; and 3.) an analysis of data from the National Medical Expenditures Panel Survey, to explore whether patterns of disparities differ between midlife and older adults, guided by specific research questions. A discussion of policy implications and recommendations for future directions for research into disparities of care, particularly among older adults, is also included.

Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. The courtesy of attribution is requested. The recommended citation follows:

Office of Health Policy, ASPE(2010) Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65)
Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

^{Skip contents}

Table of Contents

Executive Summary
1.0 Introduction
2.0 Conceptual Framework and Literature Review: Disparities in Diabetes and Other Priority Conditions

2.1 Conceptual Framework
2.2 Disparities in Diabetes Prevalence Rates
2.3 Disparities in Diabetes Complications
2.4 Disparities in Diabetes Quality of Care
2.5 Disparities in Other Priority Conditions: Examples From Cardiovascular Care and Depression
2.6 Interventions to Reduce Disparities in Diabetes and Other Priority Conditions (Cardiovascular Disease and Depression)
Summary

3.0 Disparities in Diabetes and Cardiovascular Quality of Care: An Evaluation of Adults Ages 45–64 vs. the 65 and Older Population

3.1 Background
3.2 Methods
3.3 Results
3.4 Discussion

4.0 Association of Delays, Effectiveness and Patient-Centeredness in Health Care With Age, Gender and Insurance Status Among Americans With Diabetes and Cardiovascular Conditions

4.1 Background
4.2 Methods
4.3 Results
4.4 Discussion

5.0 Summary and Recommendations

5.1 Challenges in Assessing Disparities in Quality of Care for Older Adults
5.2 Key Findings on Disparities in Care for Older Adults
5.3 Implications and Recommendations

6.0 References
7.0 Figures and Tables

Figure 1. How System and Individual Components Affect Quality of Care Disparities in Older Adults
Figure 2. Delays in Care for Diabetes and Cardiovascular Condition Patients
Figure 3. Effectiveness of Care for Diabetes and Cardiovascular Conditions
Figure 4. Patient-Centeredness Among Diabetes and Cardiovascular Condition Patients

Tables for Chapter 3

• TABLE 1: Analytic Grid for Quality Measures: Examples of Measures for Effective (Diabetes and Cardiovascular Conditions), Timely/Accessible, Patient-Centered and Safe Care
• Table 2. Published Data on Disparities in Diabetes and Cardiovascular Conditions for Commercial and Medicare Managed Care Populations, by Gender
• Table 3. Key Quality of Care Indicators for Diabetes and Cardiovascular Conditions: MEPS, 2004–2006
• Table 4. Sociodemographic Characteristics of 2004–2006 MEPS Respondents ≥45
• TABLE 5. Relative Rates based on Age and Sex for Quality of Care for Respondents With Diabetes: MEPS 2004–2006 (N=5,077)
• TABLE 6. Relative Rates Based on Age and Sex for Quality of Care for Respondents With Cardiovascular Conditions:  MEPS 2004–2006 (N= 23,235)
• TABLE 7. Relative Rates based on Race and Ethnicity for Quality of Care for Respondents With Diabetes: MEPS 2004–2006 (N=5,077)
• TABLE 8. Relative Rates based on Race and Ethnicity for Quality of Care for Respondents With Cardiovascular Conditions: MEPS 2004–2006 (N= 23,235)
• TABLE 9. Effectiveness, Access and Patient-Centeredness Among Adults With Diabetes, By Age Group, Race/Ethnicity and Sex: MEPS 2004–2006 (N=5,077)
• TABLE 10. Effectiveness, Access and Patient-Centeredness Among Adults With Cardiovascular Conditions, by Age Group, Race/Ethnicity and Sex: MEPS 2004–2006 (N=23,235)

Tables for Chapter 4

• TABLE 11. Distribution of Age, Insurance Status and Gender Characteristics Among Diabetes and  Cardiovascular Condition Patients: MEPS 2004–2006
• TABLE 12. Basic Characteristics of Diabetes and Cardiovascular Condition Patients: MEPS 2004–2006
• TABLE 13. Prevalence of Quality of Care Indicators for Diabetes and Cardiovascular Conditions, According to Patient Age Group, Insurance Status and Gender: MEPS 2004–2006
• TABLE 14. Logistic Regression Predicting Quality of Care Indicators Among Diabetes Patients, by Patient Age Group, Health Insurance Status, and Gender: MEPS 2004–2006 (n=4,076)
• TABLE 15. Logistic Regression Predicting Quality of Care Indicators Among Cardiovascular Condition Patients, by Patient Age Group, Health Insurance Status and Gender: MEPS 2004–2006 (n=17,636)

How to Obtain a Printed Copy

Where to?

Contents

Home Pages:
Office of Health Policy
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services (HHS)

Last updated:  06/24/2010