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Chronic conditions affect older Black, white patients differently

OHSU, Yale researchers find kidney disease bigger contributor for Black deaths; heart disease and depression significant factors in white deaths
Ana Quinones, Ph.D., stands near greenery at OHSU.
Ana Quiñones, Ph.D., is an associate professor in the OHSU-PSU School of Public Health and the OHSU School of Medicine’s Department of Family Medicine. (OHSU/Christine Torres Hicks)

While many of the same chronic health conditions affect most older adults in the United States, there are racial differences in the degree to which those conditions contribute to death or require advanced care, concludes a new study published in the American Journal of Epidemiology.

A collaborative effort between Oregon Health & Science University and Yale University researchers, the study dives into survey data from about 4,800 recipients of federal Medicare health insurance between 2011 and 2015. The research team found heart and kidney conditions, as well as depression and dementia, were common in the surveyed older adults. But when data was parsed by race, the researchers found those conditions affected Black and white patients differently.

“Understanding which chronic health conditions contribute to more Medicare-funded hospital or skilled nursing care can help policymakers better prepare for the future costs of government-sponsored health insurance,” said the study’s corresponding author, Ana Quiñones, Ph.D., associate professor in the OHSU-PSU School of Public Health and the OHSU School of Medicine’s Department of Family Medicine.

“This is also relevant to patients’ own lives,” Quiñones added. “Understanding which chronic conditions are more common for people with similar backgrounds may help you take preventative steps now, and reduce the chances that those conditions will lead you to need more advanced health care when you’re older.”

When looking at hospitalizations, the researchers found that heart disease caused by narrowed arteries, heart failure and kidney disease most commonly affected Medicare beneficiaries. However, the degree to which all three conditions were found in hospitalized patients was greater for Black patients. At the same time, while both chronic obstructive pulmonary disease and depression greatly contributed to white patients being hospitalized, those conditions weren’t significant factors for hospitalized Black patients.

Similar disparities were discovered when examining data of patients who were admitted to skilled nursing facilities for transitional, post-hospital care. Kidney disease, heart failure and dementia were the leading conditions for all skilled nursing patients, but those conditions were more common among Black patients. Meanwhile, two other conditions — depression and heart disease — significantly contributed only to white patients being admitted to skilled nursing facilities.

Researchers continued to find race played a role when they studied data for patients who ultimately died. Kidney disease was nearly twice as likely to contribute to the deaths of Black patients than white patients. Heart disease and depression were significant factors in the deaths of white patients, but that wasn’t the case for Black patients.

While the research team focused this study on identifying which conditions affect health outcomes experienced by Black and white patients, they suggested potential explanations for why some disparities exist. For example, knowing Black patients often have more challenges in accessing preventive care, the research team hypothesized that could be why some chronic conditions are more common among Black hospitalized patients.

This study’s main limitation is that it only explored differences along Black and white racial lines, and didn’t evaluate ethnicity. After researchers narrowed Medicare beneficiary survey data to meet their specific criteria for analysis, too few Hispanic patients remained to evaluate how or if ethnicity plays a role in health conditions and outcomes.

Quiñones and colleagues are currently conducting a similar analysis with a different data source that includes more Hispanic patients, and should also enable them to measure disparities that may be experienced by Hispanic patients.

This work was supported by several grants from the NIH’s National Institute of Aging

(RF1 AG058545, R01 AG055681, R01AG047891, P30 AG021342, R33 AG045050, P30 AG066508, U01AG032947). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 

REFERENCE: Ana R. Quiñones, Gail J. McAvay, Katherine D. Peak, Brent Vander Wyk, Heather G. Allore, “The Contribution of Chronic Conditions to Hospitalization, Skilled Nursing Facility Admission, and Death: Variation by Race,” American Journal of Epidemiology, Sept. 13, 2022, https://doi.org/10.1093/aje/kwac143

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