scholarly journals Physical Function Transitions and Healthcare Utilization Among Older Mexican Americans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 881-881
Author(s):  
Amy Givan ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Soham Al Snih
Keyword(s):  
Emergency Room ◽  
Physical Function ◽  
Healthcare Utilization ◽  
Mexican Americans ◽  
Odds Ratio ◽  
Mexican American ◽  
Negative Binomial ◽  
Medicare Beneficiaries ◽  
Physician Visits ◽  
One Year

Abstract The aim of this study was to examine the relationship between 2-year physical function transitions and one-year healthcare utilization among Mexican American Medicare beneficiaries. The sample consisted of 429 Mexican Americans ≥75 years old from the Hispanic Established Population for the Epidemiologic Study of the Elderly linked with Medicare claims data from the Centers for Medicare and Medicaid Services. Short Physical Performance Battery (SPPB) from Wave 5 (2004/05) to Wave 6 was used to create physical function transition groups. The outcomes were physician visits (<6, 6-12, >12 visits), number of emergency room visits, and number of acute hospitalizations one-year after physical function transitions. Multinomial logistic regression and Generalized Estimating Equation with negative binomial distribution were used to estimate the odds ratio of healthcare utilization as a function of physical function transition groups, controlling for socio-demographics and comorbidities. Participants who improved or remained moderate-high physical function had lower odds ratio (OR) of being hospitalized (0.40, 95% Confidence Interval [CI]=(0.18, 0.90)) or visiting the emergency room (OR=0.52, 95% CI=0.32-0.84) one-year later compared to participants who remained in the low physical function group. No difference in physician visits across physical function transition groups was found. This study showed healthcare utilization differed by physical function transition groups among Mexican American Medicare beneficiaries. Physical function improvement or maintenance of moderate-high physical function should be targeted in older Mexican Americans, a population at great risk of developing disability, to reduce or delay dependency and healthcare burden.

scholarly journals DIFFERENCES IN HOSPITALIZATIONS, ER ADMISSIONS, AND OUTPATIENT VISITS FOR MEXICAN-AMERICANS AGE 75 AND OLDER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S563-S563
Author(s):  
Brian Downer ◽  
Soham Al Snih ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Kyriakos Markides ◽  
...  
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Social Determinants ◽  
Mexican Americans ◽  
Mexican American ◽  
Outpatient Visit ◽  
Spanish Language ◽  
Medicare Beneficiaries ◽  
Outpatient Visits ◽  
Respiratory Conditions

Abstract Few studies have investigated the healthcare utilization of Mexican-American Medicare beneficiaries. We used data from 1,196 Hispanic-EPESE participants aged >75 years that has been linked with Medicare claims to describe the healthcare utilization of older Mexican-Americans and determine common reasons for hospitalizations. Participants were followed for two-years (eight-quarters). We estimated the probability of >1 hospitalization, emergency room (ER) admissions, and outpatient visits per quarter. The percentage of participants who had >1 hospitalizations, ER admissions, and outpatient visits for each quarter ranged from 10.6%-13.2%, 14.6%-19.5%, and 77.2%-80.5%, respectively. Twenty-three percent of hospitalizations were for circulatory conditions and 17% were for respiratory conditions. Older age (OR=1.26) and Spanish language (OR=1.51) were associated with hospitalizations. Women had higher odds than men to have an outpatient visit (OR=1.61). Greater education was associated with ER admissions (OR=0.72). Continued research is needed to identify social determinants and health characteristics associated with healthcare utilization among older Mexican-Americans.

scholarly journals LIFE-SPACE MOBILITY AS A PREDICTOR OF MEDICARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER MEXICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S793-S793
Author(s):  
Jason P Johnson ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Kenneth Ottenbacher ◽  
Soham Al Snih
Keyword(s):  
Mexican Americans ◽  
Mexican American ◽  
Negative Binomial ◽  
Epidemiologic Study ◽  
Negative Binomial Regression ◽  
The Elderly ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Life Space ◽  
Physician Visits

Abstract Hispanics are a large and growing group of older adults, with higher rates of morbidity and disability than other racial/ethnic groups. Mexican Americans make up more than half of this population and are well represented in the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) survey, a longitudinal study of community-dwelling older Mexican Americans. The University of Alabama Birmingham Life-Space Assessment (LSA) is a measure assessing patterns of functional mobility in and around the home, neighborhood, and community. This study addresses the gap in research of life-space mobility and healthcare utilization with linked insurance claims data. Four hundred eight participants with 1-year continuous Medicare enrollment from wave 7 (2010) of the HEPESE were linked with Medicare claims. Logistic regression analysis was used to estimate the odds ratio of hospitalization and ER admissions. Negative binomial regression was used to estimate the rate ratio of physician visits. LSA score ranges 0 to 120, with higher scores indicating greater life-space mobility; LSA was analyzed as a 10-point decrease or dichotomously as restricted ≤59 or not restricted ≥60. A restricted LSA score among older Mexican American Medicare beneficiaries was associated with OR of 2.73 for hospitalizations (95% CI= 1.18-6.31). In addition, a 5-point decline in LSA score was associated with OR of 1.12 for hospitalizations (95% CI= 1.04-1.22). LSA score was not significantly associated with ER admission or physician visit. Interventions aimed to increase mobility in the home and the community may reduce the risk of hospitalizations in this population.

scholarly journals Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia

2020 ◽  
Author(s):  
Brian Downer ◽  
Soham Al Snih ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Mukaila Raji ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Mexican Americans ◽  
Mexican American ◽  
Health Care Use ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Physician Visits ◽  
Piecewise Regression ◽  
Before And After

Abstract Background Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer’s disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD. Methods Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis. Results The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43–1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27–1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80–0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82–0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. Conclusions Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.

scholarly journals Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Brian Downer ◽  
Soham Al Snih ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Kyriakos S. Markides ◽  
...  
Keyword(s):  
Emergency Room ◽  
Mexican American ◽  
Medicare Beneficiaries ◽  
Outpatient Visits

scholarly journals Documentation of Dementia as a Cause of Death Among Mexican-American Decedents With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 59-60
Author(s):  
Brian Downer ◽  
Lin-Na Chou ◽  
Soham Al Snih ◽  
Cheyanne Barba ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Mexican Americans ◽  
Mexican American ◽  
Hospice Care ◽  
Healthcare Resource ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Medical Specialist ◽  
Physician Visits ◽  
Lower Odds

Abstract There is lack of data on the frequency and correlates of dementia being documented as a cause of death in Hispanic populations. We investigated characteristics associated with dementia as a cause of death among Mexican-American decedents diagnosed with dementia. Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims files, and the National Death Index. Of the 744 decedents diagnosed with dementia before death, 26.9% had dementia documented as a cause of death. More health comorbidities (OR=0.38, 95% CI=0.25-0.57), older age at death (OR=1.05, 95% CI=1.01-1.08), and longer dementia duration (OR=1.09, 95% CI=1.03-1.16) were associated with dementia as a cause of death. In the last year of life, any ER admission with (OR=0.56, 95% CI=0.32-0.98) or without (OR=0.31, 95% CI=0.14-0.70) a hospitalization, more physician visits (OR=0.95, 95% CI=0.92-0.98) and seeing a medical specialist (OR=0.41, 95% CI=0.24-0.70) were associated with lower odds for dementia as a cause of death. In the last 30-days of life, any hospitalization with an ICU stay (OR=0.57, 95% CI=0.37-0.88) and ER admission with (OR=0.58, 95% CI=0.40-0.84) or without (OR=0.48, 95% CI=0.25-0.94) a hospitalization were associated with lower odds for dementia as a cause of death. Receiving hospice care in the last 30-days of life was associated with 2.09 (95% CI=1.38-3.16) higher odds for dementia as a cause of death. The possible under-documentation of dementia as a cause of death on death certificates may result in underestimation of healthcare resource need of dementia care for Mexican-Americans.

scholarly journals SEX DIFFERENCE IN EARLY FRAILTY TRANSITIONS, HEALTHCARE USE, AND MEDICARE PAYMENT IN OLDER MEXICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S495-S496
Author(s):  
Chih-Ying Cynthia Li ◽  
Amol Karmarkar ◽  
Lin-Na Chou ◽  
Soham Al Snih ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Sex Difference ◽  
Mexican Americans ◽  
The Elderly ◽  
Outpatient Services ◽  
Medicare Payment ◽  
Similar Frequency ◽  
Frailty Status ◽  
One Year

Abstract This study investigated sex difference in early frailty transitions on one-year follow-up healthcare utilization and Medicare payment. We used the linked Medicare claims data and the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey, using longitudinal analyses for 789 older Mexican Americans ≥70 years old in 1998/99. Participants were divided into five transition groups: 1) remain non-frail, 2) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail), 3) remained pre-frail, 4) remained frail, 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail) based on their frailty status between Wave 3 (1998/99) and Wave 4 (2000/01). Main outcomes were: (a) healthcare utilization (hospitalization, emergency room admission, physician visit) and (b) Medicare payment (total and outpatient payments) from 2000/01 to 12 months after. Mean age was 78.8 (SD=5.1) and 60.3% were female in 1998/99. We found sex had significant interaction effects on one-year follow-up hospitalization and Medicare outpatient payment. Compared to the remained no-frail group, males who remained pre-frail (Odds Ratio [OR]= 3.62, 95% CI=1.18-11.2), remained frail (OR= 7.59. 95% CI= 1.74-33.1) and worse (OR=4.54, CI=1.74-11.8) had higher risk for hospitalization. Males in the worse group also had significantly higher Medicare outpatient payment (OR=2.58, CI=1.46-4.56). Same associations were not observed in females. However, both genders used similar frequency and type of outpatient services, as the top services were evaluation and management services. Our results suggested research is needed to examine balance between sex differences, frailty improvements, resources needed and total care expenditure in this population.

scholarly journals Documentation of Dementia as a Cause of Death Among Mexican-American Decedents Diagnosed with Dementia

2021 ◽  
pp. 1-10
Author(s):  
Brian Downer ◽  
Lin-Na Chou ◽  
Soham Al Snih ◽  
Cheyanne Barba ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Older Adults ◽  
Cause Of Death ◽  
Mexican Americans ◽  
Mexican American ◽  
Hospice Care ◽  
Epidemiologic Study ◽  
The Elderly ◽  
High Risk Population ◽  
Physician Visits ◽  
Lower Odds

Background: Hispanic older adults are a high-risk population for Alzheimer’s disease and related dementias (ADRD) but are less likely than non-Hispanic White older adults to have ADRD documented as a cause of death on a death certificate. Objective: To investigate characteristics associated with ADRD as a cause of death among Mexican-American decedents diagnosed with ADRD. Methods: Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims, and National Death Index. Results: The final sample included 853 decedents diagnosed with ADRD of which 242 had ADRD documented as a cause of death. More health comorbidities (OR = 0.40, 95% CI = 0.28–0.58), older age at death (OR = 1.18, 95% CI = 1.03–1.36), and longer ADRD duration (OR = 1.08, 95% CI = 1.03–1.14) were associated with ADRD as a cause of death. In the last year of life, any ER admission without a hospitalization (OR = 0.45, 95% CI = 0.22–0.92), more physician visits (OR = 0.96, 95% CI = 0.93–0.98), and seeing a medical specialist (OR = 0.46, 95% CI = 0.29–0.75) were associated with lower odds for ADRD as a cause of death. In the last 30 days of life, any hospitalization with an ICU stay (OR = 0.55, 95% CI = 0.36–0.82) and ER admission with a hospitalization (OR = 0.67, 95% CI = 0.48–0.94) were associated with lower odds for ADRD as a cause of death. Receiving hospice care in the last 30 days of life was associated with 1.98 (95% CI = 1.37–2.87) higher odds for ADRD as a cause of death. Conclusion: Under-documentation of ADRD as a cause of death may reflect an underestimation of resource needs for Mexican-Americans with ADRD.

scholarly journals Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

PLoS ONE ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. e0227681 ◽  
Author(s):  
Brian Downer ◽  
Soham Al Snih ◽  
Mukaila Raji ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Healthcare Utilization ◽  
Mexican American ◽  
Medicare Beneficiaries

scholarly journals The Role of Physical Activity and Physical Function on the Risk of Falls in Older Mexican Americans

2016 ◽  
Vol 24 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Zakkoyya H. Lewis ◽  
Kyriakos S. Markides ◽  
Kenneth J. Ottenbacher ◽  
Soham Al Snih
Keyword(s):  
Physical Activity ◽  
Physical Function ◽  
Mexican Americans ◽  
Mexican American ◽  
Epidemiologic Study ◽  
The Elderly ◽  
High Physical Activity ◽  
Risk Of Falls ◽  
Over Time

We investigated the relationship between physical activity and physical function on the risk of falls over time in a cohort of Mexican-American adults aged 75 and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Participants were divided into four groups according to their level of physical activity and physical function: low physical activity and low physical function (n = 453); low physical activity and high physical function (n = 54); high physical activity and low physical function (n = 307); and high physical activity and high physical function (n = 197). Using generalized linear equation estimation, we showed that participants with high physical activity and low physical function had a greater fall risk over time, followed by the high physical activity and high physical function group. Participants seldom took part in activities that improve physical function. To prevent falls, modifications to physical activity should be made for older Mexican Americans.

scholarly journals IMPACT OF DUAL SENSORY IMPAIRMENT ON HEALTH CARE INTERACTION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
Bonnielin Swenor ◽  
Bonnielin Swenor ◽  
Yasmeen Alshabasy ◽  
Emily Pedersen ◽  
Jennifer Deal ◽  
...  
Keyword(s):  
Health Care ◽  
Hearing Impairment ◽  
Odds Ratio ◽  
Vision Impairment ◽  
Sensory Impairment ◽  
Medicare Beneficiaries ◽  
Physician Visits ◽  
Using Data ◽  
The Relationship ◽  
Dual Sensory Impairment

Abstract Using data from 46,029,364 Medicare beneficiaries included in the 2015 Current Beneficiary Survey (MCBS), we examined the relationship between dual sensory impairment (DSI) – concurrent vision impairment (VI) and hearing impairment (HI) – and accompaniment to physician visits. Analyses examined reasons for accompaniment and self-reported sensory impairment was categorized as: no sensory impairment (89%), hearing impairment (HI) only (5%), vision impairment only (4%), and DSI (1%). There was no difference in odds of accompaniment among HI compared to those without sensory impairment (odds ratio [OR] = 1.04; 95% Confidence Interval [CI]: 0.84,1.29); however, VI and DSI were associated with accompaniment: (OR=2.14; [CI]:1.6,2.8 and [OR]= 2.70; [CI]:1.55,4.72, respectively). Our study further demonstrates that older adults with sensory impairment are accompanied to physician visits more often than those without sensory impairment, and transportation is the most frequently reported reason for accompaniment among adults with VI and communication for those with HI.

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