Background Older adults have been disproportionately affected by the COVID‐19 pandemic. Despite the widespread availability and proved effectiveness of COVID‐19 vaccines, the issue of inequity in vaccine uptake in the United States is a potential concern among different populations. This study examined racial and ethnic and income disparities in COVID‐19 vaccination rate among Medicare beneficiaries. Methods Data from the Medicare Current Beneficiary Survey (MCBS) COVID‐19 Winter 2021 Community Supplement were employed ( n = 9606 Medicare beneficiaries, weighted N = 50,512,963). We fitted a logistic regression model to determine the association of vaccination status with beneficiary race and ethnicity and income, after controlled for a set of beneficiary characteristics. Results Compared with non‐Hispanic White respondents, Hispanic respondents (OR = 0.72, 95% CI: 0.54–0.96, p = 0.02) and Black respondents (OR = 0.84, 95% CI: 0.67–1.04, p = 0.11) were less likely to receive COVID‐19 vaccine. In addition, the likelihood of COVID‐19 vaccine uptake for beneficiaries who earn less than $25,000 per year was more than 50% lower than that for those whose annual income was $25,000 or more (OR = 0.44, 95% CI: 0.37–0.53, p < 0.0001). Conclusions Racial and ethnic and income disparities exist in COVID‐19 vaccination rate among Medicare beneficiaries nationally. Community‐based strategies to boost vaccine uptake may target racial and ethnic minorities and socioeconomically disadvantaged groups to reduce such disparities.
Background: Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient-centered outcome.Methods: Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score (ranging 1-5) and rating status (no-rating, low-rating, and high-rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs.Results: Residents were predominately older (average 81.2 years), non-Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' riskadjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high-rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time.Conclusions: Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time.
Background Risk factors common to nursing home (NH) residents are potentially not fully captured by the Hospital Readmissions Reduction Program (HRRP). The unique challenges faced by hospitals that disproportionately serve NH residents who are at greater risk of readmissions have not been studied. Methods Using 100% Medicare Provider Analysis and Review File and the Minimum Data Set from 2010–2013, we constructed a measure of hospital share of NH‐originating hospitalizations (NOHs). We defined hospital share of NOHs as the proportion of inpatient stays by patients aged 65 or older who were directly admitted from NHs. To evaluate the impact of the share of NOHs on readmission penalties, we categorized hospitals into quartiles according to their share of NOHs and estimated the differences in the adjusted penalties across hospital quartiles after accounting for hospital characteristics, market characteristics and state fixed effects. We repeated the analyses for the penalties incurred in each year between 2015 and 2019. Results Hospitals varied substantially in the share of NOHs (median [interquartile range], 11.3% [8.2%–15.1%]), with limited variation over time. In 2015, hospitals in the highest quartile of NOH received on average 0.58% Medicare payment reduction compared to 0.44% reduction among those in the lowest quartile (32.9% higher penalties, p < 0.001). The increase in penalties continued to grow in 2017 and 2018 when the HRRP expanded to include additional target conditions (47.3% and 66.7%, respectively, p < 0.001 for both). Although the effect diminished in 2019 following the additional adjustment for hospital's dual‐eligible share, hospitals in the highest quartile of NOH still incurred 43.0% (p < 0.001) higher penalties than those in the lowest quartile. Conclusions Hospitals varied considerably in their share of NOHs. Hospitals having a higher share of NOHs were disproportionately penalized for excess readmissions, even under the revised policy that adjusts for the share of dual‐eligible admissions.
Objectives: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance. Results:The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems.Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided.Conclusions: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.