title: Disparities in receipt of recommended care among younger versus older medicare beneficiaries: a cohort study.
abstract: Although 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.
  
  
  
  We 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.
  
  
  
  At 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.
  
  
  
  Younger 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.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Na
authors.affiliation: Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.affiliation: Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee, WI, USA.|Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.affiliation: Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. hennessy@upenn.edu.|Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA. hennessy@upenn.edu.
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012307:Risk Factors; D014481:United States
keywords: Health disparity; Medicare; Quality of care; Recommended care; Younger beneficiaries