Care quality and treatment differences may underlie greater functional disability among older blacks and Latinos
Although disability rates among elders have declined overall, blacks and Latinos nevertheless continue to be burdened by more disability than whites. This may be because blacks and Latinos suffer more underlying medical problems that contribute to disability, such as diabetes and heart conditions. However, differences in care quality and treatment may also underlie the greater functional disability among older blacks and Latinos, suggests a new study.
The researchers analyzed 12 years of national data from the Health and Retirement Study (1992-2004) on community-dwelling adults older than 50 years in 1992. Their models used self-reported health care use (physician visits and hospitalizations) to predict racial/ethnic differences in disability (ability to perform activities of daily living such as dressing and bathing and mobility limitations). The models also evaluated the roles of other factors in use of health care services.
Blacks and Latinos with physician visits and hospitalizations were significantly less able to carry out activities of daily living (ADLs) than whites. Blacks with physician visits and hospitalizations and Latinos with hospitalizations also had more mobility limitations than whites. Other predisposing factors (age and sex), health needs (medical conditions and self-rated health), and enabling factors (such as economic access to health care) did not account for the greater disability among blacks and Latinos.
The findings indicate that although improving equality in economic access to health care can result in substantial reductions in disparities in access to and use of care, racial/ethnic disparities in disability would remain. This suggests that improving economic access to care may not be enough to guarantee equal access to high-quality care. The study was supported in part by the Agency for Healthcare Research and Quality (HS13819).
More details are in "Racial/ethnic differences in the relationship between the use of health care services and functional disability: The Health and Retirement Study (1992-2004)," by Mary Elizabeth Bowen, Ph.D., and Hector M. Gonzalez, Ph.D., in the October 2008 Gerontologist 48(5), pp. 659-667.
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