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Health Disparities and Missouri’s Medicaid Seniors
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By Tracy Greever-Rice, Associate Director, OSEDA; Stan Hudson, Senior Policy Analyst, Center for Health Policy, University of Missouri This paper is the third in a series published in the Missouri Senior Report that explores the nature and impact of health disparities by seniors’ demographic and socio-economic status. The 2008 paper provides an update on previous years’ analysis and provides a description of Missouri’s non-institutionalized seniors (persons 65+) enrolled in Missouri HealthNet, the state’s Medicaid program. Health Disparities and Missouri’s Medicaid Seniors As baby boomers age, seniors will account for an increasing portion of Missouri’s population. According to U.S. Census Bureau Population Estimates, seniors comprised 13.4 percent of Missourians in 2007, an uptick from 13.3 percent in 2006. As a proportion of the population, seniors are anticipated to increase to nearly 15.1 percent by 2015 and more than 19.1 percent by 2025i. The race and ethnic composition of the senior population has remained relatively stable since 1990. In 2007, approximately 92 percent of Missouri seniors were White. Blacks made up the largest portion, 7.2 percent, of the non-White senior population in 1990, while accounting for 7.4 percent in 2007. Regardless of the constancy of the race ratio, poor health outcomes disproportionately affect minority seniors.
Health Disparities & Poverty Poor seniors are less likely than the affluent to receive adequate healthcare, particularly preventative care, and more likely to forgo doctor’s visits and prescription drugsiii. Without adequate health care for acute and chronic conditions, poor seniors are more likely to experience serious complications, further exacerbating health disparities. Poor seniors experience greater disability,iv faster decline in mental capabilities,v and more limitations on daily activities.vi By definition, seniors enrolled in the Missouri HealthNet program are living in poverty. To qualify for the Missouri HealthNet program, adult participants must live in households with incomes less than $737 a month for an individual and $992 for a married couple (i.e., incomes less than 85 percent of the federal poverty guideline) and may not possess assets of more than $1,000 as individuals or $2,000 as a married couple.vii Last year 69,554 non-institutionalized seniors received services through the program. Nearly three quarters of those seniors were female. Forty-four percent (30,619) of all enrolled seniors were between the ages of 65 and 74; approximately 36 percent (24,731) were between 75 and 84; while the remaining 20 percent (14,204) were 85 and older (Missouri HealthNet Data Analysis Project, University of Missouri, 2008). Seniors enrolled in the Missouri HealthNet program were equally as likely to live in metropolitan as more rural countiesviii. Approximately 35,000, or 50.6 percent, lived in one of Missouri’s 34 metropolitan counties, while the remaining 34,400 lived in counties identified by the U.S. Census Bureau as ‘micropolitan’ (24 counties) or neither metro- or micropolitan (57 counties). Nearly one-quarter of Missouri HealthNet participants living in metropolitan counties were members of racial minorities compared to less than ten percent of participants in more rural counties. Regardless of counties’ population density, the distribution of participants by age cohort remained consistent with the state-wide age distribution.
Figure 1. Percent Non-Institutionalized Seniors by Size of County Enrolled in Missouri HealthNet Program Eighty-three percent of Missouri HealthNet-enrolled seniors identified their race as White and 12 percent as Black. The latter figure is disproportionate to Blacks as a percent of all seniors. Nearly half (47.5 percent) of the Black women receiving healthcare through the Missouri HealthNet program were between the ages of 65 and 74, compared to less than forty percent of White females in this age category. Over sixty percent of Black men served were between 65 and 74, compared to slightly less than 54 percent of White men.
Figure 2. Percent non-Institutionalized Seniors by Demographic Categories Enrolled in Missouri HealthNet
Health Disparities & Race
Figure 3. 2006 Death Rates by Race and Age, 65+ The highest levels of disparities among death rates were found for diabetes, kidney disease, Alzheimer’s disease, and atherosclerosis. Black seniors were more than twice as likely to die from diabetes, while White seniors were approximately forty percent more likely to die from Alzheimer’s disease than Blacks. White Missouri seniors died from kidney disease at a rate only three quarters that of Blacks. Similarly, White Missouri seniors died from atherosclerosis at a rate less than 70 percent of that for Blacks. Of these four diseases, only Alzheimer’s disease is not preventable (Death MICA, Missouri Department of Health and Senior Services, 2006). Diabetes is a highly treatable disease, particularly when diagnosed early and when consistently and aggressively managedx. However, a greater percent of Black seniors report barriers to many of the activities and resources known to effectively prevent and manage this chronic illness. According to both the County-Level Study and analysis of Missouri HealthNet, Black seniors in Missouri were diagnosed with diabetes at a higher rate than White seniors or Latino seniors. The Missouri County-Level Study was conducted in 2007 using survey items from the Behavior Risk Factor Surveillance Survey (BRFSS) to indicate health and wellness issues that can be addressed to better prevent or more successfully manage preventable diseases among seniors.xi Nearly 30 percent of Black seniors responding to the County-level Study reported receiving a diagnosis of diabetes, compared to less than 20 percent of White seniors and approximately 16 percent of Latino seniors. When surveyed for the 2007 County-Level Study, Black seniors were more likely than Whites or Latino respondents to report increased risk around items related to cause and management of the disease. For example, nearly 50 percent of Black seniors reported not participating in exercise during the previous month, compared to approximately 40 percent of White and 45 percent of Latino seniors. Similarly, 53.3 percent of Black seniors reported not visiting their physicians when they felt they needed to because they lacked the resources to pay for the visit, while approximately 30 percent of Whites (31.2) and only one quarter of Latinos reported forgoing medical attention due to costs. Thirty-five percent of Black seniors reported Body Mass Index scores in the ‘Obese’ range, nine percent more than did White seniors (26.1) and ten percent more than Latino seniors (25.4). Table 1 presents findings to these County-level Study items. While both death rates and selected responses from the Missouri ‘s County-Level Study provide valuable indicators of the overall status of Missouri’s senior minority population, analysis of Missouri HealthNet usage by race and gender paints a picture of the health issues faced by the poorest of Missouri’s seniors. Diagnoses for seniors enrolled in the Missouri HealthNet program reveal trends consistent with the County-Level Study, but with racial disparities more extreme for the most treatable of diseases. Black seniors enrolled in the Missouri HealthNet program were nearly 40 percent more likely to be diagnosed with diabetes than their White counterparts, 25 percent more likely to be diagnosed with heart disease, and approximately 20 percent more likely to receive services for the treatment of both stroke and kidney disease. Figure 4 describes these disparities.
Figure 4. Missouri HealthNet Diagnosis by Race
Implications Premature death results in years of productive lives lost for the family and community. Preventative treatment is less expensive than treating complications. The implications for individual seniors and their families are also significant. Quality of life is greatly reduced for these seniors, further limiting social and economic opportunities. Increased limitations in performance of daily activities reduce independence and elicit psychological distress, further contributing to physical and mental deterioration.
iMissouri State Census Data Center population projections, 2008 |
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| Missouri Senior Report is published by the State of Missouri 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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