| Popis: |
Aging race/ethnic (R/E) minorities have different patterns of healthcare utilization and are largely less likely to use healthcare resources relative to non-Hispanic Whites (NHWs). Potential explanations include differences in insurance type and economic resources. We use longitudinal latent class analysis on cognitive and functional data from the Health and Retirement Study to test (2008–2014; Unweighted n=11,140) and validate (2000–2006; Unweighted n=10,546) a predictive classification model for high-risk of cognitive disease (HRCD) among NHW, non-Hispanic Black (NHB), and Hispanic participants, 65-years and older. We use longitudinal generalized estimating equations techniques to model biennial change and R/E differences in Medicaid coverage, out-of-pocket (OOP) spending, and OOP as a proportion of family income. We classify nearly 10% of participants as HRCDs. Slightly more than 61% of HRCDs meet research specification for dementia, based on Aging, Demographics, and Memory Study criteria, and 34% died within 8-years. After adjusting for socioeconomic and demographic characteristics and comorbid conditions, HRCD NHBs (Δ=15.5%) and Hispanics (Δ=24.6%) had significantly higher probability of Medicaid coverage at baseline remaining so over the 8-years of examination. Both NHBs and Hispanics had initial (Δ=-$3,675 and Δ=-$4,222, respectively) and time-consistent lower out-of-pocket health spending but spent statistically equivalent proportions of their household income on healthcare compared to NHWs. R/E HRCDs have substantially higher Medicaid coverage and, despite lower OOP spending, dedicate an equal proportion of their household income to healthcare. We discuss the implications of these differences for disease burden, healthcare access limitations, and quality of healthcare received by older R/E minorities. |
