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Health Disparities among Seniors
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By Tracy Greever-Rice, Associate Director, OSEDA; Stan Hudson, Senior Policy Analyst, Center for Health Policy, University of Missouri Population Seniors accounted for 13.0 percent of Missouri’s population in 2006, according to U.S. Census Bureau Population Estimates. Seniors as a proportion of the population are anticipated to increase to nearly 15 percent by 2010, and more than 18 percent by 2020. The race and ethnic composition of the senior population has remained relatively stable since 1990. African American seniors made up 7.2% of the population; the percentage of White seniors was approximately 92.5%. The Hispanic senior population has increased only slightly from 0.4% in 1990 to 0.9%1 in 2006. Growth in the Hispanic population is expected to increase dramatically in the coming decades.
Socioeconomic Disparities Significant socioeconomic disparities exist among Missouri seniors, based on race and ethnicity. As seen in Figure 1, nearly 36 percent of African Americans age 65 years and older were living in households with incomes less than $20,000 per year—approximately twice the rate of White seniors and Hispanic seniors.2 Seniors in low income households are less likely to receive needed healthcare (including preventative care), and more likely to forgo physician visits and medications because they cannot afford them. Without adequate health care, seniors often experience serious complications due to undiagnosed and untreated conditions, which as they worsen, further increase existing health disparities. Poor seniors experience greater disability,3 faster decline in mental capabilities,4 and more limitations on daily life activities.5 Health Disparities by Race and Ethnicity Racial and ethnic health disparities among Missouri seniors are most apparent when comparing the death rates from many common diseases. Figure 2 presents seven common causes of death by race and ethnicity.6
The highest rates of disparities were found for hypertension, diabetes, and atherosclerosis. African American seniors were approximately twice as likely to die from these diseases as Whites. During the same period, Whites were approximately one-third more likely to die from Alzheimer’s disease than non-Whites. In 2005, Hispanics were approximately one-third more likely to die from diabetes than their non-Hispanic counterparts. Current data show fewer disparities between Hispanic and non-Hispanic Missouri seniors, however, Missouri-specific data for persons of specific ethnicities are limited. At this time, data are available for Hispanic compared to non-Hispanic populations, although Hispanic seniors’ health outcomes vary greatly, depending upon factors such as cultural heritage and economic status. Death rates provide valuable indicators to inform public policy and health care interventions intended to decrease disparities and improve outcomes for Missouri’s senior minority populations. Selected responses from the Behavior Risk Factor Surveillance Survey7 (BRFSS) indicate health and wellness factors that can be addressed to more effectively prevent and successfully manage diseases among seniors. (See Figure 3.)
For example, African American seniors are diagnosed with diabetes at a higher rate than White or Hispanic seniors in Missouri. Diabetes is a highly treatable disease, particularly when diagnosed early, and consistently managed.8 Yet a greater percent of African American seniors report barriers to many of the activities and resources known to effectively prevent and manage this chronic illness. (See Figure 4.) When surveyed for the 2004 BRFSS, nearly 36% of African American seniors and 31% of Hispanic seniors reported not participating in exercise during the previous month, compared to less than 25% of White and Non-Hispanic respondents. Similarly, a greater percentage of African American and Hispanic seniors reported not visiting their physicians, because they lacked resources to pay for the visit. Approximately 15% more African American seniors reported Body Mass Index9 scores in the ‘Obese’ range than did White seniors. Table 1 presents findings related to these BRFSS items. (See Table 1, page 11.)
Implications Racial and socioeconomic health disparities have substantial implications for Missouri communities and their senior population. Economically, communities with systemically unhealthier senior populations experience reduced productivity from both seniors and their caregivers. Moreover, preventative treatment is less expensive than treating complications of chronic illnesses. The implications are significant. Senior with chronic untreated diseases experience reduced quality of life, and further social and economic limitations. Increased difficulty in performance of daily activities reduces independence and causes distress, which further contributes to physical and mental deterioration. Best Practices To reduce racial and ethnic disparities, Missouri requires greater effort to educate providers in delivering culturally-competent health services for minority seniors.10 Intensifying recruiting efforts to create a diverse health-care workforce, more reflective of the racial and ethnic makeup of Missouri, may reduce health care disparities.11 Greater emphasis on understanding and improving the health literacy of seniors (specifically, culturally-sensitive outreach), also has potential to reduce health disparities.12 Finally, health outreach programs for minority populations have a proven track record in other states.13 Table 1 References
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| Missouri Senior Report is published by the State of Missouri’s Department of Health and Senior Services (DHSS), MU’s Office of Social and Economic Data Analysis (OSEDA) and University of Missouri Extension. |
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