Co‐occurring conditions and racial‐ethnic disparities: Medicaid enrolled adults on the autism spectrum

2021 ◽  
Author(s):  
Whitney Schott ◽  
Sha Tao ◽  
Lindsay Shea
Keyword(s):  
Ethnic Disparities ◽  
Autism Spectrum ◽  
Racial Ethnic

scholarly journals Racial/Ethnic Disparities in the Identification of Children With Autism Spectrum Disorders

2009 ◽  
Vol 99 (3) ◽  
pp. 493-498 ◽  
Author(s):  
David S. Mandell ◽  
Lisa D. Wiggins ◽  
Laura Arnstein Carpenter ◽  
Julie Daniels ◽  
Carolyn DiGuiseppi ◽  
...  
Keyword(s):  
Autism Spectrum Disorders ◽  
Ethnic Disparities ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorders ◽  
Racial Ethnic

scholarly journals Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251353
Author(s):  
Teal W. Benevides ◽  
Henry J. Carretta ◽  
George Rust ◽  
Lindsay Shea
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Health Insurance ◽  
Ethnic Disparities ◽  
Autism Spectrum ◽  
Public Health Insurance ◽  
Racial And Ethnic Disparities ◽  
Dual Eligible ◽  
Data Source ◽  
Racial Ethnic

Background Research on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs. Methods We conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending. Findings The majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries. Conclusions Public health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities.

Study finds racial/ethnic disparities in depressive trajectories among middle-aged or older adults

2012 ◽  
Author(s):  
J. Liang ◽  
X. Xu ◽  
A. R. Quinones ◽  
J. M. Bennett ◽  
W. Ye
Keyword(s):  
Older Adults ◽  
Ethnic Disparities ◽  
Middle Aged ◽  
Racial Ethnic

1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1489-P
Author(s):  
SHARON SHAYDAH ◽  
GIUSEPPINA IMPERATORE ◽  
CARLA MERCADO ◽  
KAI M. BULLARD ◽  
STEPHEN R. BENOIT
Keyword(s):  
United States ◽  
Ethnic Disparities ◽  
Diabetic Coma ◽  
Racial Ethnic

scholarly journals Association Between Out-Of-Pocket Costs, Race/Ethnicity, and Adjuvant Endocrine Therapy Adherence Among Medicare Patients With Breast Cancer

2017 ◽  
Vol 35 (1) ◽  
pp. 86-95 ◽  
Author(s):  
Albert J. Farias ◽  
Xianglin L. Du
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Ethnic Disparities ◽  
Medication Possession Ratio ◽  
Adjuvant Endocrine Therapy ◽  
Hormone Receptor Positive ◽  
Medication Costs ◽  
Poverty Status ◽  
Racial Ethnic ◽  
Out Of Pocket Costs

Purpose Previous studies suggest that adherence to adjuvant endocrine therapy (AET) for patients with breast cancer is suboptimal, especially among minorities, and is associated with out-of-pocket medication costs. This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to AET and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. Methods This retrospective cohort study used the SEER-Medicare linked database to identify patients ≥ 65 years of age with hormone receptor–positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. The cohort included non-Hispanic whites, blacks, Hispanics, and Asians. Out-of-pocket costs for AET medications were standardized for a 30-day supply. Adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET (tamoxifen or AIs) was assessed using the medication possession ratio (≥ 80%) during the 12-month period. Results Of 8,688 patients, 3,197 (36.8%) were nonadherent to AET. Out-of-pocket costs for AET medication were associated with lower adjusted odds of adherence for all four cost categories compared with the lowest category of ≤ $2.65 ( P < .01). In the univariable analysis, Hispanics had higher odds of adherence to any AET at initiation (OR, 1.30; 95% CI, 1.07 to 1.57), and blacks had higher odds of adherence to AIs at initiation (OR, 1.27; 95% CI, 1.04 to 1.54) compared with non-Hispanic whites. After adjusting for copayments, poverty status, and comorbidities, the association was no longer significant for Hispanics (OR, 0.95; 95% CI, 0.78 to 1.17) or blacks (OR, 0.96; 95% CI, 0.77 to 1.19). Blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (OR, 0.54; 95% CI, 0.31 to 0.93) after adjusting for socioeconomic, clinic, and prognostic factors. Conclusion Racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.

scholarly journals Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Chirag Vyas ◽  
Charles Reynolds ◽  
David Mischoulon ◽  
Grace Chang ◽  
Olivia Okereke
Keyword(s):  
Native American ◽  
Ethnic Differences ◽  
Ethnic Disparities ◽  
Late Life ◽  
Geographic Region ◽  
Omega 3 ◽  
Late Life Depression ◽  
Item Level ◽  
Racial Ethnic ◽  
Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

scholarly journals Physical Activity as a Mediator in the Relationship Between Race or Ethnicity and Changes in Multimorbidity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 342-342
Author(s):  
Jason Newsom ◽  
Emily Denning ◽  
Ana Quinones ◽  
Miriam Elman ◽  
Anda Botoseneanu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sex Education ◽  
Chronic Conditions ◽  
Structural Equation ◽  
Insurance Coverage ◽  
Ethnic Disparities ◽  
Later Life ◽  
Equation Modeling ◽  
The Relationship ◽  
Racial Ethnic

Abstract Racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time have been established. Studies report differences in physical activity across racial/ethnic groups. We investigated whether racial/ethnic differences in accumulation of multimorbidity over a 10-year period (2004-2014) were mediated by physical activity using data from the Health and Retirement Study (N = 10,724, mean age = 63.5 years). Structural equation modeling was used to estimate a latent growth curve model of changes in the number of self-reported chronic conditions (of nine) and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) to change in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, personal wealth, and insurance coverage. Results indicated that Blacks engaged in significantly lower levels of physical activity than Whites (b = -.171, □ = -.153, p &lt; .001), but there were no differences between Hispanics and Whites (b = -.010, □ = -.008, ns). Physical activity also significantly predicted both lower initial levels of multimorbidity (b = -1.437, □ = -.420, p &lt; .001) and greater decline in multimorbidity (b = -.039, □ = -.075, p &lt; .001). The indirect (mediational) effect for the Black vs. White comparison was significant (b = .007, □ = .011, 95% CI [.004,.010]). These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in middle and later life, suggesting greater need to reduce sedentary behavior and increase activity.

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