A methodology for identifying married couples in medicare data: Mortality, morbidity, and health care use among the married elderly

Iwashyna, Theodore J.; Zhang, James; Lauderdale, Diane S.; Christakis, Nicholas A.

doi:10.2307/3004010

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…(20, 21) Married couples in the 1993 Medicare Denominator file, which contains 96% of all elderly Americans,(22) were identified using a published detection algorithm. (23) In order to satisfy computer hardware constraints we drew an 8% simple random sample from the pool of all identified married couples, which we further restricted to those couples in which both spouses were either white or black, aged 67–98 at baseline, not enrolled in an HMO, living in the 50 states or D.C., and sharing the same zip code (to exclude married but separated couples). The final sample contains 373,189 married couples, or 746,378 men and women.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

2008

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Objectives We investigate the effect of spousal bereavement on mortality, and we extend prior work by documenting cause-specific bereavement effects by the causes of death both of the pre-decedent spouse and the bereaved survivor. Methods We examined a nationally representative cohort of 373,189 elderly married couples in the United States, followed from 1993 to 2002, using competing-risk and Cox models. Covariates included the baseline health of both spouses. Results In both men and women, there is significant variation in the effect of widowhood on mortality as a function of the causes of death of both spouses. The death of a spouse due to almost all causes, including various cancers, infections, and cardiovascular diseases, increases the mortality of the surviving spouse, albeit to varying degrees. Conversely, the death of a spouse increases survivor’s cause-specific mortality for almost all causes, including cancers, infections, and cardiovascular diseases, albeit to varying degrees. Conclusions The effect of widowhood on mortality varies substantially by the causes of death of both spouses, suggesting that the widowhood effect is not restricted to one aspect of human biology.

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Section: Methodsmentioning

confidence: 99%

The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

2008

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“…In the first step of data development, Medicare beneficiaries older than 65 years on January 1, 1993, in the Denominator File were identified. Among the 32,180,588 elderly in this file, we estimate, based on Census statistics, that there are 6.6 million currently married heterosexual couples where both members are 65 years and older, of which we detected 5,496,444 (Iwashyna, Brennan, Zhang, & Christakis, 2002;Iwashyna et al, 1998). Since individuals typically enter Medicare at age 65 years, we restricted the analysis to couples where both partners were older than 67 years at baseline in order to guarantee the availability of a full two years of health background controls for the entire sample.…”

Section: Datamentioning

confidence: 98%

“…Medicare databases are uniquely suited for research on contextual variation in the widowhood effect as they provide prospective information for over 96% of elderly Americans (whether they used health care or not) with daily mortality follow-up (Hatten, 1980), permit (with some constraints) the identification of both spouses of elderly married couples (Iwashyna, Zhang, Lauderdale, & Christakis, 1998), contain detailed physician-ascertained medical information to control for baseline differences in morbidity, and identify the place of residence of all participants, thus permitting extensive record linkage for contextual features of the residential environment. In the first step of data development, Medicare beneficiaries older than 65 years on January 1, 1993, in the Denominator File were identified.…”

Section: Datamentioning

confidence: 99%

Widowhood and mortality among the elderly: The modifying role of neighborhood concentration of widowed individuals

Subramanian

Elwert

Christakis

2008

Social Science & Medicine

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The effect of death of a spouse on the mortality of the survivor (the "widowhood effect") is wellestablished. We investigated how the effect of widowhood on mortality depends on the neighborhood concentration of widowed individuals in the United States. We developed a large, nationally representative, and longitudinal dataset from Medicare claims and other data sources characterizing 200,000 elderly couples, with nine years of follow-up (1993-2002), and estimated multilevel grouped discrete-time hazard models. In neighborhoods with a low concentration of widowed individuals, widowhood increased the odds of death for men by 22% and for women by 17%, compared to 17% for men, and 15% for women in neighborhoods with a high concentration of widowed individuals. Our findings suggest that neighborhood structural contexts -that provide opportunities for interacting with others and favoring new social engagements -could be potential modifiers of the widowhood effects and as such requires more systematic consideration in future research of widowhood effects on well-being and mortality.

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“…Other factors, for example, patients' marital status, geographic location, and socioeconomic status, may be possible prognostic factors for patients with advanced cancers. 20 Various environmental considerations 21 were considered as possible prognostic factors for these patients. Based on these prognostic factors, prognostic tools were developed for cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Predicting Survival Time in Noncurative Patients with Advanced Cancer: A Prospective Study in China

Cui

Zhou

Wee

et al. 2014

Journal of Palliative Medicine

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Background: Accurate prediction of prognosis for cancer patients is important for good clinical decision making in therapeutic and care strategies. The application of prognostic tools and indicators could improve prediction accuracy. Objective: This study aimed to develop a new prognostic scale to predict survival time of advanced cancer patients in China. Methods: We prospectively collected items that we anticipated might influence survival time of advanced cancer patients. Participants were recruited from 12 hospitals in Shanghai, China. We collected data including demographic information, clinical symptoms and signs, and biochemical test results. Log-rank tests, Cox regression, and linear regression were performed to develop a prognostic scale. Results: Three hundred twenty patients with advanced cancer were recruited. Fourteen prognostic factors were included in the prognostic scale: Karnofsky Performance Scale (KPS) score, pain, ascites, hydrothorax, edema, delirium, cachexia, white blood cell (WBC) count, hemoglobin, sodium, total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP) values. The score was calculated by summing the partial scores, ranging from 0 to 30. When using the cutoff points of 7-day, 30-day, 90-day, and 180-day survival time, the scores were calculated as 12, 10, 8, and 6, respectively. Conclusions: We propose a new prognostic scale including KPS, pain, ascites, hydrothorax, edema, delirium, cachexia, WBC count, hemoglobin, sodium, total bilirubin, direct bilirubin, AST, and ALP values, which may help guide physicians in predicting the likely survival time of cancer patients more accurately. More studies are needed to validate this scale in the future.

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A methodology for identifying married couples in medicare data: Mortality, morbidity, and health care use among the married elderly

Cited by 23 publications

References 21 publications

The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

Widowhood and mortality among the elderly: The modifying role of neighborhood concentration of widowed individuals

Predicting Survival Time in Noncurative Patients with Advanced Cancer: A Prospective Study in China

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