Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 4.1 Background


Collectively, diabetes and cardiovascular disease account for nearly 30 percent of all deaths in the U.S. and an estimated $623 billion in direct and indirect medical costs (AHRQ 2008; CDC 2009). These diseases are among the most prevalent chronic conditions in midlife and older adult populations 45 and older. Their impact on overall health and disability is profound, but can be minimized through effective management and quality care.

There have been significant efforts to evaluate the quality of diabetes and cardiovascular care among midlife and older adult populations. Current literature suggests that access to care and receiving needed care are key issues among midlife adults (45–64), many of whom have chronic conditions (Collins et al 2006; Hoffman and Schwartz 2008; McWilliams et al 2003). The literature further suggests that Medicare improves access to care and reduces disparities in use of services for virtually all older adults 65 and older who are eligible for coverage (NASI 2006; Williams 2004).

However, while there have been evaluations of quality of care for diabetes and cardiovascular conditions, few large-scale studies have considered health insurance status. Health insurance coverage may affect the ability to pay for care and access to care, particularly timeliness of care, and women may be differentially affected (Glied et al 2008; Patchias and Waxman 2007; Rustgi et al 2009). Existing studies have not often provided comparative results from the Medicare population, which has high rates of chronic conditions but whose insurance status differs from midlife adults. Nor have studies always differentiated between the experiences of women and men, despite previous literature demonstrating gender disparities in select diabetes and cardiovascular outcomes, such as increased risk of diabetes complications and under-receipt of appropriate clinical procedures among women (Chou et al 2007a, 2007b).

This chapter examines the relationship of age, gender and insurance status to quality of care—particularly timeliness of care—among Americans with diabetes and cardiovascular conditions. Using a large-scale, nationally representative survey, this study examined whether gender and insurance are related to self-reported delays in care among midlife adults (45–64) and older adults (>65) with diabetes and cardiovascular conditions.

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