CHRONIC AND DISABLING CONDITIONSC

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CHRONICCONDITIONS AFFECTOVER HALF OFOLDER ADULTSPROPORTION OF ADULTSAGES 50 AND OLDER WITHA COMMON CHRONICCONDITION

SOURCE: Center on an Aging Society analysesof data from the 1999 Medical ExpenditurePanel Survey.

70

60

50

40

30

20

10

0

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HISPANICS NON-HISPANIC NON-HISPANICBLACKS WHITES

5661

54

This Profile examines Hispanic and non-Hispanicadults ages 50 and older with any of five commonchronic conditions including arthritis, cancer, dia-

betes, heart disease, and hypertension or high bloodpressure. Among the non-Hispanic population, differ-ences between black and white adults are examined.Due to sample size limitations, racial differences amongthe Hispanic population cannot be reported.

Similar proportions of Hispanic and non-Hispanic populations have common chronicconditionsOver 41 million Americans ages 50 and older have anyof five common chronic conditions. Almost 3 millionof adults with these conditions are Hispanic Americans.Some 56 percent of Hispanics and 54 percent of non-Hispanics have at least one condition. Also, similarproportions — 39 percent of Hispanic and 37 percentof non-Hispanic adults — have multiple conditions.

There are important differences among the non-Hispanic population. The proportion of blacks that haveone or multiple conditions is higher than the proportionof whites. Regardless of ethnicity or race, however,older people with higher incomes are less likely to haveseveral chronic conditions, compared to those withlower incomes.

Older HispanicAmericans

NU

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9

■M

AY

2

00

3

Less care for chronic conditions

Similar proportions of Hispanic and non-Hispanic adults ages 50 and older have com-

mon chronic conditions. Although the two populations use hospital services to a similar

extent, the Hispanic population is less likely to visit physicians, and much less likely to

see other health professionals. Health care expenditures are lower for Hispanics than

non-Hispanics with chronic conditions, and a larger proportion of Hispanic adults is

uninsured. Hispanics adults with chronic conditions report that they are more likely

to have difficulty obtaining health care and are less satisfied with their care, compared

to non-Hispanic adults with chronic conditions.

Center on an Aging SocietyG E O R G E T O W N U N I V E R S I T Y

D A T A P R O F I L E

F I G U R E 1

Proportion of Older Adults with Chronic Conditions Using Various Health Care Servicesin the Past Year

HISPANICS (%) NON-HISPANICS

All (%) Blacks (%) Whites (%)

PHYSICIANS 87 93 91 93NON-PHYSICIANS 25 41 19 44EMERGENCY ROOM 15 17 21 17OVERNIGHT HOSPITAL STAY 16 18 18 18PRESCRIPTION DRUGS 90 95 95 95

SOURCE: Center on an Aging Society analyses of data from the 1999 Medical Expenditure Panel Survey.

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Hispanic adults are less likely touse “non-physician” services Hispanics are somewhat less likely thannon-Hispanics to see a physician, andmuch less likely to use services providedby health professionals other than physi-cians such as optometrists, psychologists,chiropractors, physical and occupationaltherapists, or social workers. Among thenon-Hispanic population, blacks are muchless likely than whites to use non-physi-cian services. Hispanic adults also use non-physician services with less frequency(see Figure 1). Among adults with chronicconditions, 48 percent of Hispanics and57 percent of non-Hispanics made two ormore visits in a year to health profession-als other than physicians. Differences inhospital use between the Hispanic andnon-Hispanic populations are not great.

Insurance may have an impact onhealth service useDifferences in health service use may berelated to differences in health insurancecoverage. Adults with limited or no healthinsurance coverage may not be able orwilling to pay for non-physician services,which may not be considered as essentialas doctor or hospital visits or prescriptiondrugs. Even among the insured, those withless comprehensive plans may not have

coverage for some non-physician services.For example, differences in the use of pre-scription drugs may be related to the factthat less than one-third of older Hispanicadults with chronic conditions have cover-age for prescription drugs, compared tohalf of older non-Hispanic adults withchronic conditions. Among non-Hispanicadults, blacks are less likely than whitesto have coverage (see Figure 2).

F I G U R E 2

Proportion of Older Adults, with ChronicConditions, Who Have Prescription DrugCoverage

SOURCE: Center on an Aging Society analyses of data from the1999 Medical Expenditure Panel Survey.

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HISPANICS NON-HISPANIC NON-HISPANICBLACKS WHITES

39

60

50

40

30

20

10

0

31

52

F I G U R E 4

Proportion of Adults Ages 65 and Older withChronic Conditions, by Type of Health Insurance

SOURCE: Center on an Aging Society analyses of data from the 1999Medical Expenditure Panel Survey.

0 20 40 60 80

P E R C E N T

MEDICARE ONLY MEDICARE AND MEDICAIDMEDICARE AND PRIVATE

34

NON-HISPANICWHITES

NON-HISPANICBLACKS

HISPANICS

30

31

31

7

60

36

39

20

F I G U R E 3

Proportion of Adults Ages 50 to 64 with ChronicConditions, by Type of Health Insurance

SOURCE: Center on an Aging Society analyses of data from the 1999 MedicalExpenditure Panel Survey.

0 20 40 60 80 100

P E R C E N T

UNINSUREDMEDICAIDANY PRIVATE

12

NON-HISPANICWHITES

NON-HISPANICBLACKS

HISPANICS

18

66

7

8

85

27

24

50

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Over one-quarter of Hispanics ages50 to 64 with a chronic condition areuninsuredAmong adults ages 50 to 64 with a com-mon chronic condition, 27 percent ofHispanics are uninsured. This is more thantwice the proportions of non-Hispanicblacks and whites who are uninsured. TheHispanic population is the least likely tohave private insurance (see Figure 3).

Employment-related factors may con-tribute to the higher proportions of unin-sured Hispanics. A substantial percentage ofHispanic workers are employed in low-wagejobs and work in sectors that do not offerhealth insurance benefits.1, 2

Hispanic adults with chronicconditions rely on public insuranceAlmost one-quarter of Hispanics, ages 50 to64 with chronic conditions, are covered byMedicaid. Smaller proportions of their non-Hispanic counterparts have Medicaid cover-age, however (see Figure 3).

Among the population age 65 and older,larger proportions of Hispanics than non-Hispanics rely solely on public insurance,including Medicare and Medicaid. Forexample, the proportion of Hispanics cov-ered by both Medicare and Medicaid — 39percent — is more than five times that ofnon-Hispanic whites — 7 percent. Non-Hispanic whites are much more likely thanHispanics and non-Hispanic blacks to haveprivate insurance (see Figure 4).

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Health care expenditures are lowerfor Hispanic adults than for othersMedian health care expenditures for thenon-Hispanic population — $2,494 — areabout 40 percent higher than expendituresfor the Hispanic population — $1,785.Substantial differences exist among thenon-Hispanic population, however (seeFigure 5). Differences in expenditures like-ly reflect differences in health care serviceuse and insurance coverage.

Medicaid pays for over one-quarterof health care for Hispanic adultswith chronic conditionsMedicaid pays for a substantially largerportion of total health care expendituresfor Hispanics than for non-Hispanics.Medicare and private insurance pay a larg-er portion of health care expenditures fornon-Hispanic adults than for Hispanicadults, however (see Figure 6).

THE HISPANIC POPULATIONUSES FEWER DISEASEMANAGEMENT SERVICESHispanic Americans with chronic conditions areless likely than non-Hispanic Americans to takepart in disease management activities. Amongadults with diabetes, high blood pressure, orheart disease, Hispanics are less likely to receiveservices that help monitor and control theseconditions. For example, 71 percent of Hispanicshave their blood pressure checked every sixmonths, compared to 80 percent of whites and89 percent of African Americans. Additionally,some 73 percent of whites and 84 percent ofAfrican Americans with diabetes report havingtheir eyes checked in the past year, comparedto 66 percent of Hispanics with diabetes.3

F I G U R E 5

Median Health Care Expenditures forOlder Adults with Chronic Conditions

SOURCE: Center on an Aging Society analyses of data from the1999 Medical Expenditure Panel Survey.

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HISPANICS NON-HISPANIC NON-HISPANICBLACKS WHITES

$1,786

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

$1,785

$2,616

F I G U R E 6

Proportion of Total Health Care Expenditures for Older Adultswith Chronic Conditions, by Payer Source

100

80

60

40

20

0

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SOURCE: Center on an Aging Society analyses of data from the 1999 Medical ExpenditurePanel Survey.

HISPANICS NON-HISPANIC BLACKS NON-HISPANIC WHITES($15 BILLION) ($25 BILLION) ($204 BILLION)

T O T A L H E A L T H C A R E E X P E N D I T U R E S

OUT-OF-POCKETOTHERPRIVATEMEDICAREMEDICAID

14

522

31

28

14

533

35

14

18

730

41

4

CHRONIC AND DISABLING CONDITIONSC

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er proportion of the Hispanic populationhas trouble making appointments withtheir health care providers (see Figure 7).Even with an appointment, Hispanicadults wait longer to be seen by theirprovider (see Figure 8).

Hispanic adults are somewhat lesssatisfied with their careAlthough the majority of each popula-tion is satisfied with the quality of care,a smaller proportion of Hispanics thannon-Hispanics report that they are verysatisfied with their care — 74 percent and83 percent, respectively. Hispanic adultsare also less satisfied than non-Hispanicadults with the staff where they receivetheir care. There are no substantial differ-ences in satisfaction between whites andblacks in the non-Hispanic population.

Patient-physician communication bar-riers are one factor that may contributeto lower satisfaction among the Hispanicpopulation. Compared to non-Hispanicwhites and blacks, Hispanics — and par-ticularly Hispanics whose primary lan-guage is not English — are most likelyto experience difficulty communicatingwith their physicians.4

The Hispanic population has moredifficulty obtaining health careSimilar proportions of the Hispanic andnon-Hispanic populations ages 50 andolder report that they have a usual sourceof health care. Hispanic adults are almosttwice as likely to report that they havedifficulty obtaining health care, however.One reason may be that a somewhat larg-

F I G U R E 7

Proportion of Older Adults with ChronicConditions Reporting Difficulties ObtainingHealth Care

SOURCE: Center on an Aging Society analyses of data from the1999 Medical Expenditure Panel Survey.

30

25

20

15

10

5

0

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HISPANICS NON-HISPANIC NON-HISPANICBLACKS WHITES

13

26

ANY DIFFICULTY OBTAINING CAREDIFFICULTY MAKING ANAPPOINTMENT WITH PROVIDER

7

18

7

23

HISPANICS

F I G U R E 8

Length of Time Older Adults with Chronic Conditions Wait to be Seen by their Providerwith an Appointment

SOURCE: Center on an Aging Society analyses of data from the 1999 Medical Expenditure Panel Survey.

36%≤ 15

MINUTES

33%> 30

MINUTES

31%16 TO 30MINUTES

NON-HISPANIC WHITES

55%≤ 15

MINUTES

16%> 30

MINUTES

29%16 TO 30MINUTES

NON-HISPANIC BLACKS

42%≤ 15

MINUTES

28%> 30

MINUTES

30%16 TO 30MINUTES

ABOUT THE PROFILESThis is the second set of Data Profiles in the series, Challengesfor the 21st Century: Chronic and Disabling Conditions. The seriesis supported by a grant from the Robert Wood Johnson Founda-tion. This Profile was written by Lee Shirey and Laura Summer.Previous Profiles in the new series include:

1. Screening for Chronic Conditions: Underused services2. Childhood Obesity: A lifelong threat to health3. Visual Impairments: A growing concern as the population ages4. Cancer: A national concern 5. Prescription Drugs: A vital component of health care6. Chronic Obstructive Pulmonary Disease: A chronic condition

that limits activities 7. Rural and Urban Health: Health care service use differs8. Chronic Back Pain: A leading cause of work limitations

The Center on an Aging Society is a Washington-based nonpar-tisan policy group located at Georgetown University’s Institutefor Health Care Research and Policy. The Center studies theimpact of demographic changes on public and private institu-tions and on the economic and health security of families andpeople of all ages.

ABOUT THE DATAUnless otherwise noted, the data presented inthis Profile are from the 1999 Medical Expen-diture Panel Survey (MEPS), cosponsored by theAgency for Healthcare Research and Quality andthe National Center for Health Statistics, pro-vides national estimates of health care use,expenditures, sources of payment, and insurancecoverage. The MEPS asks respondents to reportany current medical conditions.

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2233 Wisconsin Avenue NWSuite 525Washington, DC 20007

TEL 202.687.9840FAX 202.687.3110

WEBSITE www.aging-society.org

Center on an Aging SocietyG E O R G E T O W N U N I V E R S I T Y

DATA PROF ILESARE AVA ILABLE ON L INESIGN UP FOR EMAIL ALERTS AT

WWW.AGING-SOCIETY.ORG

Hispanic adults are more likely toreport fair to poor healthAlthough similar proportions of Hispanicand non-Hispanic adults have multiplechronic conditions, self-reported healthstatus differs. Among adults with at leastone chronic condition, 38 percent ofHispanics, compared to 27 percent of non-Hispanics, report fair to poor physicalhealth. Among the non-Hispanic popula-tion, however, the proportion of blacksreporting fair to poor health is higherthan the proportion of whites.

Among older adults with chronic condi-tions, those with lower incomes are sub-stantially more likely to report poorerhealth. Regardless of income, however, theHispanic population is more likely to reportfair to poor health (see Figure 9).

1. CoveringTheUninsured.org (2003). “Who is Most Likely to beUninsured?,” Fact Sheet. The Robert Wood Johnson Foundation:Princeton, NJ.

2. E. R. Brown, et al. (2000). “Racial and Ethnic Disparities in Accessto Health Insurance and Health Care,” Policy Research Report. UCLACenter for Health Policy Research and The Henry J. Kaiser FamilyFoundation.

3. K. Scott Collins et al. (2002). Diverse Communities, CommonConcerns: Assessing Health Care Quality for Minority Americans.The Commonwealth Fund: New York, NY.

4. Ibid.

F I G U R E 9

Proportion of Older Adults with Chronic ConditionsReporting Fair to Poor Physical Health, by Income

SOURCE: Center on an Aging Society analyses of data from the 1999 MedicalExpenditure Panel Survey.

0 10 20 30 40 50

P E R C E N T

HISPANICSNON-HISPANIC BLACKSNON-HISPANIC WHITES

$50,000 +

< $20,000

1721

23

354848