Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011–2019
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Dependent Variables
2.3. Independent Variables
2.4. Covariates
2.5. Statistical Analysis
3. Results
4. Discussion
4.1. Expenditure Trends and Differences by Gender, Race, and Ethnicity
4.2. Other Drivers of Expenditures by Gender
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All | Men | Women | |
---|---|---|---|
(n = 52,639) | (n = 19,378) | (n = 33,261) | |
Race/Ethnicity | |||
NHW | 419,693,009 (74.62%) | 171,208,656 (77.17%) | 248,484,352 (72.96%) |
NHB | 64,009,730 (11.38%) | 21,920,637 (9.88%) | 42,089,093 (12.36%) |
Hispanic | 48,535,036 (8.63%) | 17,374,300 (7.83%) | 31,160,736 (9.15%) |
NH Asian | 14,162,016 (2.52%) | 5,256,219 (2.37%) | 8,905,797 (2.62%) |
NH Other or Multiple Races | 16,033,875 (2.85%) | 6,109,485 (2.75%) | 9,924,390 (2.91%) |
Age (continuous) | 61.59 ± 13.86 | 61.17 ± 13.46 | 61.86 ± 14.04 |
(N = 562,433,667) | (N = 221,869,299) | (N = 340,564,368) | |
Marital Status | |||
Married | 309,745,376 (55.07%) | 143,407,888 (64.64%) | 166,337,488 (48.84%) |
Widowed/Divorced/Separated | 192,704,101 (34.26%) | 53,497,530 (24.11%) | 139,206,571 (40.88%) |
Never Married | 59,984,190 (10.67%) | 24,963,881 (11.25%) | 35,020,309 (10.28%) |
Education | |||
<High School | 70,216,080 (12.48%) | 26,581,612 (11.98%) | 43,634,468 (12.81%) |
High School or GED | 219,635,486 (39.05%) | 86,131,808 (38.82%) | 133,503,678 (39.20%) |
College or more | 207,137,876 (36.83%) | 82,756,875 (37.30%) | 124,381,001 (36.52%) |
Missing | 65,444,225 (11.64%) | 26,399,004 (11.90%) | 39,045,220 (11.46%) |
Employment Status | |||
Employed | 329,481,959 (58.58%) | 118,687,204 (53.49%) | 210,794,755 (61.90%) |
Not employed/will return to work | 231,614,437 (41.18%) | 102,516,384 (46.21%) | 129,098,053 (37.91%) |
Missing | 1,337,271 (0.24%) | 665,711 (0.30%) | 671,560 (0.20%) |
Region | |||
Northeast | 102,592,927 (18.24%) | 39,431,180 (17.77%) | 63,161,747 (18.55%) |
Midwest | 132,339,179 (23.53%) | 53,647,347 (24.18%) | 78,691,832 (23.11%) |
South | 215,983,523 (38.4%) | 84,100,509 (37.91%) | 131,883,014 (38.72%) |
West | 111,518,038 (19.83%) | 44,690,263 (20.14%) | 66,827,775 (19.62%) |
Poverty Status | |||
Poor/Negative | 73,759,729 (13.11%) | 24,143,084 (10.88%) | 49,616,645 (14.57%) |
Near poor | 28,8714,34 (5.13%) | 9,971,414 (4.49%) | 18,900,020 (5.55%) |
Low income | 80,983,829 (14.4%) | 28,019,402 (12.63%) | 52,964,427 (15.55%) |
Middle income | 154,650,174 (27.5%) | 59,526,635 (26.83%) | 95,123,539 (27.93%) |
High income | 224,168,501 (39.86%) | 100,208,765 (45.17%) | 123,959,737 (36.40%) |
Comorbidity Count | 2.34 ± 1.72 | 2.47 ± 1.74 | 2.25 ± 1.68 |
(N = 562,433,667) | (N = 221,869,299) | (N = 340,564,368) | |
Insurance Coverage | |||
Any private | 346,691,499 (61.64%) | 143,757,961 (64.79%) | 202,933,538 (59.59%) |
Public only | 188,988,436 (33.60%) | 67,098,833 (30.24%) | 121,889,603 (35.79%) |
Uninsured | 26,753,731 (4.76%) | 11,012,504 (4.96%) | 15,741,227 (4.62%) |
Functional Limitation | |||
Yes | 201,125,122 (35.76%) | 72,189,249 (32.54%) | 128,935,873 (37.86%) |
No | 360,229,814 (64.05%) | 149,236,798 (67.26%) | 210,993,016 (61.95%) |
Missing | 1,078,731 (0.19%) | 443,252 (0.20%) | 635,479 (0.19%) |
Patient Health Questionnaire | |||
Depressed | 67,308,777 (11.97%) | 24,854,328 (11.20%) | 42,454,449 (12.47%) |
Not depressed | 440,827,287 (78.38%) | 174,856,579 (78.81%) | 265,970,708 (78.10%) |
Missing | 54,297,603 (9.65%) | 22,158,391 (9.99%) | 32,139,211 (9.44%) |
Usual Source of Care | |||
Yes | 501,670,327 (89.2%) | 195,082,176 (87.93%) | 306,588,151 (90.02%) |
No | 54,195,165 (9.64%) | 24,088,287 (10.86%) | 30,106,878 (8.84%) |
Missing | 6,568,175 (1.17%) | 2,698,836 (1.22%) | 3,869,339 (1.14%) |
Delayed medical care | |||
Yes | 42,973,222 (7.64%) | 15,315,370 (6.90%) | 27,657,853 (8.12%) |
No | 517,629,666 (92.03%) | 205,711,234 (92.72%) | 311,918,431 (91.59%) |
Missing | 1,830,778 (0.33%) | 842,695 (0.38%) | 988,084 (0.29%) |
Could not afford or unable to get medical care | |||
Yes | 25,966,092 (4.62%) | 8,648,235 (3.90%) | 17,317,857 (5.09%) |
No | 534,709,720 (95.07%) | 212,398,449 (95.73%) | 322,311,271 (94.64%) |
Missing | 1,757,854 (0.31%) | 822,615 (0.37%) | 935,240 (0.27%) |
MEN | ||||||
All *** Mean (95% CI) | NHW *** Mean (95% CI) | NHB ** Mean (95% CI) | Hispanic Mean (95% CI) | NHA Mean (95% CI) | NHO * Mean (95% CI) | |
2011–2013 | $2240 (2093, 2387) | $2403 (2231, 2575) | $1650 (1338, 1962) | $1696 (1306, 2806) | $1980 (883, 3078) | $1246 (867, 1625) |
2014–2016 | $2499 (2285, 2712) | $2618 (2365, 2871) | $2170 (1734, 2605) | $2151 (1478, 2824) | $1484 (977, 1992) | $2212 (1025, 3398) |
2017–2019 | $2838 (2689, 3018) | $3056 (2830, 3282) | $2331 (1866, 2796) | $1993 (1551, 2435) | $1984 (1225, 2743) | $2056 (1528, 2584) |
WOMEN | ||||||
All *** Mean (95% CI) | NHW *** Mean (95% CI) | NHB ** Mean (95% CI) | Hispanic *** Mean (95% CI) | NHA Mean (95% CI) | NHO Mean (95% CI) | |
2011–2013 | $2390 (2233, 2547) | $2510 (2320, 2700) | $1952 (1661, 2243) | $1951 (1585, 2318) | $1781 (1367, 2195) | $3213 (1063, 5363) |
2014–2016 | $2536 (2364, 2709) | $2695 (2469, 2921) | $2098 (1758, 2438) | $2017 (1781, 2254) | $1810 (1265, 2356) | $2678 (2096, 3260) |
2017–2019 | $3097 (2926, 3268) | $3237 (3035, 3439) | $2478 (2183, 2774) | $2719 (2215, 3222) | $2355 (1100, 3611) | $4112 (2740, 5484) |
All | Men | Women | |
---|---|---|---|
Marginal Costs (95% CI) | Marginal Costs (95% CI) | Marginal Costs (95% CI) | |
Race/Ethnicity | |||
NHW (REF) | - | - | - |
NHB | −284.01 *** | −272.68 | −317.06 * |
Hispanic | −50.55 | −153.64 | −17.26 |
NHA | −315/16 | −601.49 *** | −182.59 |
NHO | −161.73 | −604.84 ** | 135.32 |
Age | |||
18–34 (REF) | - | - | - |
35–54 | 22.27 | 80.28 | 53.94 |
55–74 | 53.75 | 270.56 | −34.90 |
75+ | −19.52 | 408.58 | −254.59 |
Marital Status | |||
Married (REF) | - | - | - |
No longer married | 42.85 | −67.80 | 110.15 |
Never Married | 148.11 | 25.48 | 236.85 * |
Education | |||
<High School (REF) | - | - | - |
High School or GED | 508.20 *** | 563.23 *** | 456.37 *** |
College or more | 852.48 *** | 750.00 *** | 872.13 *** |
Region | |||
Northeast (REF) | - | - | - |
Midwest | −189.02 * | −70.52 | −259.97 * |
South | −243.05 * | −24.10 | −382.82 *** |
West | 23.33 | 235.30 * | −91.71 |
Poverty Status | |||
Poor/Negative (REF) | - | - | - |
Near poor | 140.75 | 108.82 | 173.55 |
Low income | 58.40 | −66.97 | 134.27 |
Middle income | 259.08 *** | 168.16 | 312.46 ** |
High income | 697.49 *** | 552.00 ** | 823.62 *** |
Comorbidity Count | 245.83 *** | 241.64 *** | 247.02 *** |
Insurance Coverage | |||
Any private (REF) | - | - | - |
Public only | −402.94 *** | −317.96 *** | −460.84 *** |
Uninsured | 1068.06 *** | −833.16 ** | −1215.73 ** |
PHQ-2 | |||
Not depressed (REF) | - | - | - |
Depressed | 298.63 *** | 367.56 ** | 249.85 * |
Usual Source of Care | |||
No (REF) | - | - | - |
Yes | 755.37 *** | 683.35 * | 742.32 ** |
Delayed Medical Care | |||
No (REF) | - | - | - |
Yes | 405.97 *** | 305.05 | 461.68 ** |
Could Not Afford or Unable to Get Medical Care | |||
No (REF) | - | - | - |
Yes | −38.66 | −129.15 | −7.48 |
Year | |||
2011–2013 (REF) | - | - | - |
2014–2016 | 46.63 | 56.27 | 40.79 |
2017–2019 | 436.36 *** | 280.91 ** | 539.91 *** |
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Spector, A.L.; Matsen, E.; Egede, L.E. Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011–2019. Int. J. Environ. Res. Public Health 2022, 19, 9014. https://doi.org/10.3390/ijerph19159014
Spector AL, Matsen E, Egede LE. Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011–2019. International Journal of Environmental Research and Public Health. 2022; 19(15):9014. https://doi.org/10.3390/ijerph19159014
Chicago/Turabian StyleSpector, Antoinette L., Emily Matsen, and Leonard E. Egede. 2022. "Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011–2019" International Journal of Environmental Research and Public Health 19, no. 15: 9014. https://doi.org/10.3390/ijerph19159014