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Disparities in Antidepressant Treatment in Medicaid Elderly Diagnosed with Depression
Author(s) -
Strothers Harry S.,
Rust George,
Minor Patrick,
Fresh Edith,
Druss Benjamin,
Satcher David
Publication year - 2005
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2005.53164.x
Subject(s) - medicaid , medicine , depression (economics) , antidepressant , odds ratio , logistic regression , confidence interval , psychiatry , ethnic group , gerontology , demography , health care , anxiety , sociology , anthropology , economics , macroeconomics , economic growth
Objectives: To determine whether there were racial or ethnic disparities in the use of antidepressants in low‐income elderly patients insured by Medicaid. Design: Examination of 1998 Medicaid claims data. Setting: Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states. Participants: All Medicaid recipients aged 65 to 84 with a diagnosis of depression. Measurements: Treatment versus no treatment; in those treated, treatment with drugs was classified as old‐ or new‐generation antidepressants. Results: In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African‐American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long‐term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62–2.24). Patients in long‐term care facilities and those aged 65 to 74 were less likely to receive treatment. Conclusion: Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African‐American patients.