Racial disparities in hospitalization expenditures of older adults in Singapore

Abstract The World Population Prospects 2019 reports that the proportion of people who aged 65 and above takes up 9 per cent globally in 2019, reaching up to 16 per cent by 2050. Asia has the fastest rise: from 1 in 9 people aged 65 and above to 1 in 4 in 2050. Rapid growth in older adults has strong implications for diseases and healthcare expenditure. For Singapore, the transition from ‘ageing society’ (7% seniors) in 1999 to ‘super-aged society’ (20% seniors) in 2026 is projected to take 27 years, much faster than Japan’s 36 years. We used the Singapore Multi-Ethnic Cohort (MEC) of 14,465 subjects aged 21 to 94, and the Future Elderly Model (FEM) microsimulation model to project disease burden and hospitalization expenditures to 2050. We found that Chinese females had the highest life expectancy of 86.0 years, followed by Indian and Malay females with 80.4 and 75.6 years respectively. In all racial groups, women lived longer than men by 5-7 years. Cumulative hospitalization expenditures of older adults aged 51+ was US$69,500 for Chinese, US$67,600 for Malays and US$86,100 for Indians; US$71,200 for males and US$70,700 for females. The increased hospitalization spending for all three ethnic groups was due to the underlying manifestation of chronic diseases, including diabetes, hypertension, heart disease and stroke. Variations in environmental risk factors such as diet, cigarette smoking and physical activity across ethnic groups may contribute to racial differences in chronic diseases and disability. Therefore, targeted interventions are needed to reduce racial disparities.

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Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2474 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 704-704

Author(s):

Yuchi Young ◽

Barbara Resnick

Keyword(s):

Older Adults ◽

Health Care ◽

Health Systems ◽

Long Term Care ◽

The United States ◽

World Population ◽

Term Care ◽

The Usa ◽

Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

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Factors Underlying Racial Disparities in Sepsis Management

Healthcare ◽

10.3390/healthcare6040133 ◽

2018 ◽

Vol 6 (4) ◽

pp. 133

Author(s):

Matthew DiMeglio ◽

John Dubensky ◽

Samuel Schadt ◽

Rashmika Potdar ◽

Krzysztof Laudanski

Keyword(s):

Racial Disparities ◽

Racial Differences ◽

Minority Groups ◽

The United States ◽

Racial Groups ◽

Sepsis Management ◽

Treatment Protocols ◽

Common Causes ◽

Standardized Treatment ◽

Wide Variability

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.491 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Oluwole M Adegbala ◽

Akintunde Akinjero ◽

Samson Alliu ◽

Adeyinka C Adejumo ◽

Emmanuel Akintoye ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

African Americans ◽

Length Of Stay ◽

Hospital Mortality ◽

Racial Disparities ◽

Racial Differences ◽

Length Of Hospital Stay ◽

The United States ◽

Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

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Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults

Journal of the International Neuropsychological Society ◽

10.1017/s1355617715000806 ◽

2015 ◽

Vol 21 (9) ◽

pp. 677-687 ◽

Cited By ~ 12

Author(s):

Sze Yan Liu ◽

M. Maria Glymour ◽

Laura B. Zahodne ◽

Christopher Weiss ◽

Jennifer J. Manly

Keyword(s):

Older Adults ◽

African American ◽

African Americans ◽

Racial Disparities ◽

Racial Differences ◽

Cognitive Aging ◽

School Attendance ◽

Cognitive Outcomes ◽

Older Americans ◽

Years Of Schooling

AbstractRacially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9% of the variance in years of schooling, 6% of memory, and 12% of language. Among HRS African Americans, state of school attendance accounted for 13% of the variance in years of schooling and also contributed to variance in cognitive function (7%), memory (2%), and vocabulary (12%). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education. (JINS, 2015, 21, 677–687)

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Active elderly and health—can moderate exercise improve health and wellbeing in older adults? Protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05278-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mauro Giovanni Carta ◽

Giulia Cossu ◽

Elisa Pintus ◽

Rosanna Zoccheddu ◽

Omar Callia ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Older Adults ◽

Chronic Diseases ◽

The Elderly ◽

Moderate Physical Activity ◽

World Population ◽

Medical Reason ◽

Positive Effects

Abstract Background Aging is marked by a progressive rise in chronic diseases with an impact on social and healthcare costs. Physical activity (PA) may soothe the inconveniences related to chronic diseases, has positive effects on the quality of life and biological rhythms, and can prevent the decline in motor functions and the consequent falls, which are associated with early death and disability in older adults. Methods We randomized 120 over-65 males and females into groups of similar size and timing and will give each either moderate physical activity or cultural and recreational activities. Being younger than 65 years, inability to participate in physical activity for any medical reason, and involvement in a massive program of physical exercise are the exclusion criteria. The primary outcome measures are: quality of life, walking speed, and postural sway. Participants are tested at baseline, post-treatment, and 6-month (24 weeks) and 12-month (48 weeks) follow-ups. Discussion This study aims at improving the quality of life, wellness, and cognitive functioning in the elderly through a low-cost affordable program of moderate physical activity. Given the growing aging of the world population and the social and economic burden of disability in the elderly, our results might have a major impact on future practices. Trial registration ClinicalTrials.gov NCT03858114. Registered on 28 February 2019.

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Achieving Healthcare Equity: Disparities in Diagnosis, Quality of Care, and Outcomes Among People With Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.2303 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 665-666

Author(s):

Maricruz Rivera-Hernandez ◽

Amit Kumar ◽

Amit Kumar

Keyword(s):

Older Adults ◽

Quality Of Care ◽

Ethnic Groups ◽

Racial Differences ◽

Ethnic Disparities ◽

Public Health Problem ◽

The United States ◽

Community Dwelling ◽

Racial And Ethnic Disparities

Abstract Alzheimer’s disease and Related Dementia (ADRD) is a significant public health problem and improving the quality and efficiency of care for older adults with ADRD is a national priority. Approximately five million older adults in the United States, including 50% of nursing home residents and 20% of community-dwelling elderly, have ADRD or probable dementia. Although, the number of minorities affected by ADRD growing at an alarming rate, the diagnosis of ADRD and supportive care for this condition are more likely to be delayed among racial/ethnic minority groups. Given the need to ensure equity of care among racial and ethnic groups, there is a pressing need to understand disparities in diagnosis, access and quality of care among racial and ethnic groups with ADRD, specifically using nationally representative data. This symposium will feature four presentations that provide novel insight regarding racial disparities among people with ADRD in the community-, institution-based post-acute, and long-term settings. Individual presentations will describe 1) racial and ethnic differences in risk and protective factors of dementia and cognitive impairment without dementia; 2) racial and ethnic disparities in high-quality home health use among persons with dementia; 3) Within- and between-nursing homes racial and ethnic disparities in resident’s outcomes for people with ADRD; and 4) racial differences in transition to post-acute care and rehab utilization following hip fracture related hospitalization in patients with ADRD. Finally, there will be a discussion regarding policy and clinical implications, as well directions for future research.

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Ethnic Differences in Magnesium Intake in U.S. Older Adults: Findings from NHANES 2005–2016

Nutrients ◽

10.3390/nu10121901 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1901 ◽

Cited By ~ 2

Author(s):

Sarah Jackson ◽

Lee Smith ◽

Igor Grabovac ◽

Sandra Haider ◽

Jacopo Demurtas ◽

...

Keyword(s):

Older Adults ◽

African American ◽

African Americans ◽

Ethnic Groups ◽

Later Life ◽

Targeted Interventions ◽

Magnesium Intake ◽

Health And Nutrition ◽

Dietary Magnesium ◽

Using Data

Magnesium plays a crucial role in hundreds of bodily processes relevant to aging, but consumption of dietary magnesium intake has been shown to be inadequate in a large proportion of older adults. Identifying groups at risk of low magnesium intake is important for informing targeted advice. Using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2016, we examined the association between ethnicity (Caucasian/African American/Hispanic/other) and magnesium intake in a large representative sample of U.S. older adults (≥65 y, n = 5682, mean (SD) 72.9 (0.10) y). Analyses adjusted for total energy intake and a range of relevant covariates. Overall, 83.3% of participants were not meeting the recommended level of dietary magnesium intake, ranging from 78.1% of other ethnic groups to 90.6% of African Americans. In the fully adjusted model, magnesium intake was lower among African American older adults (−13.0 mg/d, 95% CI: −18.8 to −7.2), and higher among Hispanics (14.0 mg/d, 95% CI: 7.5 to 20.5) and those from other ethnic groups (17.2, 95% CI: 3.8 to 30.5) compared with Caucasian older adults. These results highlight the need for targeted interventions to increase magnesium intake in U.S. older adults, with a focus on African Americans, in order to reduce the burden of morbidity and ethnic inequalities in health in later life.

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Racial Health Disparities in Coronavirus Deaths

10.5772/intechopen.96361 ◽

2021 ◽

Author(s):

Daniel L. Howard

Keyword(s):

United States ◽

African American ◽

Health Disparities ◽

African Americans ◽

Racial Disparities ◽

Racial Differences ◽

Causes Of Death ◽

Current Trend ◽

Racial Groups ◽

Racial Health Disparities

Preliminary racial data on the coronavirus pandemic indicates that African Americans are much more likely to experience infections, hospitalizations, and death from the virus in comparison to other racial groups. While this appears to be an alarming health outcome regarding African Americans, it is, in fact, not surprising, nor even new information, considering the historical context of racial health disparities and the marginal health of African Americans in the United States. The leading causes of death for African Americans generally and historically reflects the leading causes of death for the entire United States population. More research, and obviously data, is needed to fully understand the factors that cause the overall racial health disparities, in general, and racial disparities in coronavirus cases and deaths, in particular. In the case of the coronavirus pandemic, the racial disparities in deaths reflect racial differences in the way that African Americans live, work, and exist as a result of their ‘second-class citizenship’ with respect to their lower socioeconomic status in comparison to other racial groups. From a health policy perspective, challenges exist to reversing the current trend in coronavirus deaths among African Americans due to a myriad of historic, consistent, and pervasive societally-induced deficits within African American life. The proposed chapter will rely on systematic review of the extant literature on racial health disparities to identify multiple factors that may affect African American deaths due to the current coronavirus pandemic. The chapter will also rely on this framework to inform evidence-based approaches to improve public health for African Americans.

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Race, Lifetime SES, and Allostatic Load among Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab160 ◽

2021 ◽

Author(s):

Courtney S Thomas Tobin ◽

Taylor W Hargrove

Keyword(s):

Older Adults ◽

Racial Disparities ◽

Racial Differences ◽

Allostatic Load ◽

Health Benefits ◽

Black Americans ◽

Health Study ◽

Downward Mobility ◽

Black And White ◽

Socioeconomic Resources

Abstract Background Prior research demonstrates that Black Americans receive fewer health benefits at high levels of SES relative to Whites. Yet, few studies have considered the role of lifetime SES (i.e. changes in SES from childhood to adulthood) in shaping these patterns among older adults. This study investigates the extent to which racial disparities in allostatic load (AL), an indicator of accelerated physiological aging, vary across levels of lifetime SES among Black and White adults aged 50+. Methods With data from the Nashville Stress and Health Study, modified Poisson regression models were used to assess racial differences in the odds of high AL (4+ high-risk biomarkers) among Black and White older adults (N=518) within each level of lifetime SES (i.e., stable low SES, upward mobility, downward mobility, stable high SES). Results Stable high SES was associated with greater odds of high AL; there was not a significant association between other lifetime SES trajectories and AL. However, the magnitude of racial disparities varied across levels of lifetime SES, with a significant Black-White difference in AL observed only among upwardly mobile (OR=1.76, 95% CI=1.24-2.51) and high SES groups (OR=2.22, 95% CI=1.37-3.58). Conclusions Our study demonstrates that racial disparities in AL among older adults depends on individuals’ lifetime SES trajectories, and that older Black Americans receive fewer health benefits for achieving higher SES. These findings underscore the need to evaluate socioeconomic resources across the life course to clarify the extent of racial disparities among aging populations.

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Factors Underlying Racial Disparities in Sepsis Management

10.20944/preprints201810.0192.v1 ◽

2018 ◽

Author(s):

Matthew DiMeglio ◽

John Dubensky ◽

Samuel Schadt ◽

Rashmika Potdar ◽

Krzysztof Laudanski

Keyword(s):

Racial Disparities ◽

Racial Differences ◽

Minority Groups ◽

The United States ◽

Racial Groups ◽

Sepsis Management ◽

Treatment Protocols ◽

Common Causes ◽

Standardized Treatment ◽

Wide Variability

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, wide variability in clinical outcomes persist across racial groups. Specifically, Black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the Caucasian population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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