Usha Sambamoorthi

Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women.

BACKGROUND In this article we estimate the variations in receipt of age-appropriate preventive services among adult women between 21 and 64 years of age, by race and ethnic group, socioeconomic status, and access to health care. We also assess whether differences in access to care and socioeconomic status may explain racial and ethnic differences in the use of preventive services. METHOD Nationally representative data on adult women from the Medical Expenditure Panel Survey were used to estimate the effect of socioeconomic characteristics on the receipt of each preventive service. Receipt of each of four preventive services-cholesterol test, blood pressure reading, and two cancer screening tests (Papanicolaou smear, mammogram)-according to the 1996 recommendations of the U.S. Preventive Services Task Force were examined. RESULTS An overwhelming majority of adult women (93%) had had a blood pressure reading within the last 2 years. Eighty-four percent of women had had their cholesterol checked within the last 5 years. Seventy-five percent of women had received a mammogram and 80% received Pap tests. College education, high income, usual source of care, and health insurance consistently predicted use of preventive services. These factors also explained ethnic disparities in the receipt of preventive services between Latinas and white women. CONCLUSIONS The results from our study are encouraging because only a minority of women do not receive age-appropriate preventive services. However, low socioeconomic status, lack of insurance, and lack of a usual source of care represent significant barriers to preventive care for adult women.

Diagnosis and Treatment of Depression in the Elderly Medicare Population: Predictors, Disparities, and Trends

Objectives: To develop nationally representative estimates of rates of diagnosis of depression; to determine rates and type of treatment received by those diagnosed with depression; and to ascertain socioeconomic differences and trends in treatment rates of depression, including the effect of supplemental insurance coverage, for elderly Medicare fee‐for‐service beneficiaries.

Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression

AbstractOBJECTIVE: To characterize the prevalence and predictors of diagnosed depression among persons with HIV on Medicaid and antidepressant treatment among those diagnosed, and to compare utilization and costs between depressed HIV-infected individuals treated with and without antidepressant medications. DESIGN: Merged Medicaid and surveillance data were used to compare health services utilized by depressed individuals who were or were not treated with antidepressant medications, controlling for other characteristics. SETTING AND PARTICIPANTS: The study population comprised Medicaid recipients in New Jersey who were diagnosed with HIV or AIDS by March 1996 and received Medicaid services between 1991 and 1996. MEASUREMENTS AND MAIN RESULTS: Logistic regression and ordinary least squares regressions were employed. Women were more likely and African Americans were less likely to be diagnosed with depression. Women and drug users in treatment were more likely to receive antidepressant treatment. Depressed patients treated with antidepressants were more likely to receive antiretroviral treatment than those not treated with antidepressants. Monthly total expenditures were significantly lower for individuals diagnosed with depression and receiving antidepressant therapy than for those not treated with antidepressants. After controlling for socioeconomic and clinical characteristics, treatment with antidepressant medications was associated with a 24% reduction in monthly total health care costs. CONCLUSIONS: Depressed HIV-infected patients treated with antidepressants were more likely than untreated subjects to receive appropriate care for their HIV disease. Antidepressant therapy for treatment of depression is associated with a significantly lower monthly cost of medical care services.

the Diverse Older Hiv-positive Population: A National Profile of Economic Circumstances, Social Support, and Quality of Life

Summary: The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle‐aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross‐sectional analysis of nationally representative interview data on HIV‐infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co‐variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than

Drug abuse, methadone treatment, and health services use among injection drug users with AIDS☆

25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than

Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey.

10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV‐positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.

Health Care Expenditures of Living With a Disability: Total Expenditures, Out-of-Pocket Expenses, and Burden, 1996 to 2004

This paper compares health care use across subgroups of injection drug users (IDUs) with AIDS, as defined by current drug abuse status and participation in methadone maintenance treatment (MMT), using surveillance-identified IDU status and health care claims data. Merged Medicaid and AIDS surveillance data were analyzed using ordinary least squares regression, simple logistic regression and multinomial logistic regression. Consistent MMT was more likely among women, Whites and older subjects. Monthly total expenditures and inpatient expenditures were significantly lower for IDUs in MMT than for IDUs with claims indicative of current drug abuse. Consistent participation in MMT was associated with a higher probability of antiretroviral use and, among antiretroviral users, more consistent use of antiretrovirals. Merged administrative data sets can be an important data source that illuminate the relationships among drug abuse, drug treatment, and HIV-related health care. For AIDS-infected IDUs, consistent MMT may lower barriers to receipt of appropriate HIV-related health care and reinforce adherence to medical recommendations.

Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDS.

OBJECTIVES This study sought to identify and characterize seriously mentally ill patients with HIV infection. METHODS Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or no serious mental illness. RESULTS Of 8294 individuals, 476 (5.7%) were classified as having schizophrenia, and 564 (6.8%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to have claims indicative of substance abuse. CONCLUSIONS Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection.

The prevalence and persistence of sliding scale insulin use among newly admitted elderly nursing home residents with diabetes mellitus.

OBJECTIVE To estimate the health care expenditures associated with a disability and their recent trends. DESIGN Retrospective analysis of survey data. SETTING Not applicable. PARTICIPANTS Data from multiple years (1996-2004) of the Medical Expenditure Panel Survey (MEPS) for a nationally representative sample of civilian, noninstitutionalized U.S. population. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Health care expenditures consisted of total health care expenditures, total out-of-pocket (OOP) spending, and burden (the ratio of OOP to family income). All the analyses accounted for the complex survey design of the MEPS. RESULTS Between 1996 and 2004, 6% to 9% of persons in the working-age group (21-61 y) were identified as having a disability. Persons with disabilities consistently had higher total health expenditures, OOP spending, and burden compared with their counterparts without disabilities. In 2004, the average total expenditures were estimated at

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

10,508 for persons with disabilities and at