title: Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.
abstract: The objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need.
  
  
  
  Data were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+ years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need.
  
  
  
  Racial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos.
  
  
  
  Expenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Center on Aging and Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Jimenez
authors.affiliation: Center on Aging and Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Schmidt
authors.affiliation: Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
authors.forename: Giyeon
authors.initials: G
authors.lastname: Kim
authors.affiliation: Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA.
authors.forename: Benjamin Le
authors.initials: BL
authors.lastname: Cook
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: comorbidities; older adults; racial/ethnic disparities