Health Care Disparities

The Agency for Healthcare Research and Quality (AHRQ) tracks disparities in some core measures and reports annually in their Disparities Report (AHRQ, 2003, 2007). The following summary of disparities among elders from minority categories as compared to Non-Hispanic Whites is based on those and other reported sources of disparities in health services for older adults or Medicare patients (Epstein, et al. 2003; Groeneveld, 2003; Schneider et al, 2001; Schneider et al., 2002; Smedley et al., 2003).

African Americans/Blacks compared to Non-Hispanic Whites

Preventive Services

Lower rates of pneumococcal and influenza vaccinations

Acute Illness Treatment

• Lower rates of a wide variety of treatments for cardiac problems and stroke
• Fewer antibiotics treatment for pneumonia patients
• Fewer recommended treatments (breast conserving surgery plus radiation) instead of mastectomy for local breast cancer
• Lower rates of recommended hospital care for patients with pneumonia
• Hospitalized patients were more likely to have adverse drug events associated with insulin or oral hypoglycemics
• Higher rates of postoperative complications

Chronic Disease Management

• Three times higher rates for lower extremity amputations in patients with diabetes
• Lower rate of eye examinations for patients with diabetes
• Less follow-up after hospitalization for mental illness
• Higher proportion of long stay high risk nursing home residents with pressure sores
• Higher proportion of home health patients who had to be admitted to hospital
• Hospice patients whose families reported that they did not receive end of life care consistent with their wishes was almost two times higher
• Higher percentage of hospice patients whose family reported they did not receive the right amount of medicine for pain

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Asians compared to Non-Hispanic Whites

National level data is not available for Asian subgroups, and Pacific Islander populations were included with Asians in earlier data sets (API) but are too small to be covered independently in most of the latest data sets.

Preventive Services

• Lower rates of pneumococcal vaccinations
• Lower rates of mammograms

Acute Illness Treatment

• Less appropriate timing of antibiotics received by patients having surgery
• Lower rates of recommended hospital care for patients with pneumonia

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Chronic Disease Management

• Higher rates of being physically restrained among nursing home patients
• Hospice patients whose families reported that they did not receive end of life care consistent with their wishes was more than three times higher
• Higher percentage of hospice patients whose family reported they did not receive the right amount of medicine for pain

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American Indians/Alaska Natives compared to Non-Hispanic Whites

Preventive Services

Lower rates of mammograms

Acute Illness Treatment

Lower proportion of tuberculosis patients who complete a curative course of treatment

Chronic Disease Management

• Lower proportion of patients with heart failure who received the recommended hospital care
• Higher proportion of long stay high risk nursing home residents with pressure sores
• Higher proportion of home health patients who had to be admitted to hospital
• Hospice patients whose families who reported that they did not receive end of life care consistent with their wishes was more than two times higher
• Higher percentage of hospice patients whose family reported they did not receive the right amount of medicine for pain

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Hispanics compared to Non-Hispanic Whites

Preventive Services

• Rates of pneumococcal vaccination half that of NHWs

• Lower rates of mammograms

Acute Illness Treatment

Lower rates of recommended hospital care for patients with pneumonia

Chronic Disease Management

• More lower extremity amputations in patients with diabetes
• Lower proportion of patients with heart failure who received the recommended hospital care
• Higher proportion of home health patients who had to be admitted to hospital
• Higher rates of being physically restrained among nursing home patients
• Higher proportion of long stay high risk nursing home residents with pressure sores
• Hospice patients whose families reported that they did not receive end of life care consistent with their wishes was more than two times higher
• Higher percentage of hospice patients whose family reported they did not receive the right amount of medicine for pain

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