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The Impact of Health Service Use on Racial Differences in Mortality among the Elderly

Southern Illinois University, Carbondale

Barbara S. Kilbourne

Tennessee State University, Nashville

Van A. Cain

Tennessee State University, Nashville

Pamela C. Hull

Tennessee State University, Nashville

Robert S. Levine

Morehouse School of Medicine, Atlanta

Baqar A. Husaini

Tennessee State University, Nashville

The authors investigated the impact of socioeconomic conditions, patterns of morbidity, and health service use on Black—White differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician billing data and Medicare Enrollment Database (EDB) were analyzed to assess physician-diagnosed morbidity, health service use, and mortality among the population of Medicare beneficiaries in Tennessee (N = 665,887). Proportional hazards models were used to examine the effects of socioeconomic status, morbidity, and service use on race differences in mortality. Racial differences in physician visits explain the largest portion of mortality differentials between Black Americans and Whites. Race disparities in mortality associated with particular forms of morbidity are also partly a function difference in health service use. Our findings suggest that Black—White mortality differentials could be narrowed by increasing Black Americans' access to physician services.

Key Words: Medicare beneficiaries • mortality • physician services • racial disparities

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