Explaining Race Differences in Mortality among the Tennessee Medicare Elderly: The Role of Physician Services

We investigated the impact of socioeconomic conditions, patterns of morbidity, and physician service utilization on race differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician Billing F...

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Bibliographic Details
Published inJournal of health care for the poor and underserved Vol. 16; no. 4; pp. 50 - 63
Main Authors Sherkat, Darren E, Kilbourne, Barbara S, Cain, Van A, Hull, Pamela C, Levine, Robert S, Husaini, Baqar A
Format Journal Article
LanguageEnglish
Published United States Johns Hopkins University Press 01.11.2005
Subjects
African Americans
Aged
Female
Government programs
Health services
Health Services Research
Humans
Longitudinal Studies
Male
Medicare
Medicare - utilization
Morbidity
Mortality
Older people
Physicians - utilization
Racial differences
Socioeconomic factors
Socioeconomics
Tennessee - epidemiology
Tennessee
United States > US
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Summary:We investigated the impact of socioeconomic conditions, patterns of morbidity, and physician service utilization on race differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician Billing File data and the Medicare Enrollment Database (EDB) were analyzed to assess physician-diagnosed morbidity, health service use, and mortality, among the population of Medicare beneficiaries in Tennessee (N=665,887). Proportional hazards models were used to examine the effects of race, socioeconomic status, morbidity, and physician service utilization on mortality. Race differences in physician visits explain the largest portion of mortality differentials between African Americans and Whites. Race disparities in mortality associated with particular forms of morbidity are also mostly a function of differences in physician service use. Our examination suggested that race differences in patterns of physician service use principally explain race disparities in mortality. Further, race differences in the use of physician services were substantially responsible for race disparities in mortality associated with particular forms of morbidity.
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ISSN:1049-2089
1548-6869
1548-6869
DOI:10.1353/hpu.2005.0072