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Does Disability Affect Receipt of Preventive Care Services among Older Medicare Beneficiaries?


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Volume 8 - July 2017

Does Disability Affect Receipt of Preventive Care Services among Older Medicare Beneficiaries?

Key Findings:
  • Medicare beneficiaries reporting any type of disability were less likely than beneficiaries reporting no disability to receive cancer screenings and more likely to receive routine preventive care.
  • Among Medicare beneficiaries aged 65 and older, females reporting any type of disability were less likely to receive mammography screening compared to those reporting no disability.
  • Compared to beneficiaries reporting no disability, receipt of pneumococcal vaccination was consistently higher among beneficiaries ages 65 and older reporting any type of disability.
Data Source: 2013 Medicare Current Beneficiary Survey.
Woman sitting on a table using braille

Introduction

Preventive care services (such as influenza and pneumococcal vaccinations) and cancer screenings (such as routine mammography) are important for mitigating illnesses and disease progression.[1,2,3] In 2013, 48,031 persons ages 65 and older died from influenza and pneumonia in the United States.[4] In the same year, 22,870 women ages 65 and older died from breast cancer.[5] These data underscore the importance of broad access to preventive pneumonia and influenza vaccinations,[1,3] as well as screenings to detect cancer in its earliest, most treatable stage.[6]

Disability may impede access to preventive care. Adults with disabilities—especially those who have substantial mobility impairments or need help with routine and personal care needs—have been found to be less likely to receive mammograms, Papanicolaou (Pap) tests, and pneumococcal vaccinations compared to adults with no disability.[7] Physical accessibility to exam rooms and diagnostic equipment, particularly for adults with disabilities who use mobility devices, may contribute to restricted access to preventive care.[8,9]

Although previous studies have examined receipt of preventive services across a range of disability types,[10,11] none have so far attempted to align disability types with the 2011 Department of Health and Human Services (HHS) guidance regarding disability status data collection standards.[12] This new guidance, specifying six disability types, bring clarity and uniformity to the definition of disability. According to data collected consistent with the HHS guidance, 36.4 percent of Americans ages 65 and older had a hearing, visual, cognitive, ambulatory, self-care, or independent living disability in 2013.[13] We present data from the 2013 Medicare Current Beneficiary Survey (MCBS), an in-person, nationally representative, longitudinal survey of Medicare beneficiaries sponsored by the Centers for Medicare & Medicaid Services (CMS). Using measures available in the MCBS that are similar to the HHS disability status data collection implementation guidance (see Table 1 for a comparison), this study examined differences in self-reported receipt of preventive care by type of disability for community-dwelling Medicare beneficiaries ages 65 and older.[i]

2013 MCBS 2011 HHS Implementation Guidance
Hearing Beneficiary reported a lot of trouble hearing or reported being deaf. Beneficiary reported being deaf or having serious difficulty hearing.
Visual Beneficiary reported a lot of trouble seeing or reported being blind. Beneficiary reported being blind or having serious difficulty seeing, even when wearing glasses
Cognitive Beneficiary reported having trouble concentrating or keeping his/her mind on what s/he is doing, problems making decisions to the point that it interferes with daily activities, or experiencing memory loss such that it interferes with daily activities. Beneficiary reported having serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition.
Ambulatory Beneficiary reported that, because of a health or physical problem, s/he finds it difficult or is unable to walk a quarter-mile; an inability to stoop, crouch, or kneel; or a lot of difficulty stooping, crouching, or kneeling. Beneficiary reported serious difficulty walking or climbing stairs.
Self-Care Beneficiary reported that, because of a health or physical problem, s/he finds it difficult or is unable to bathe, shower, dress, eat, get in or out of bed or chairs, or use the toilet. Beneficiary reported difficulty dressing or bathing.
Independent Living Beneficiary reported that, because of a health or physical problem, s/he finds it difficult or is unable to shop for personal items, prepare meals, manage money, use the telephone, or do housework. Beneficiary reported having difficulty doing errands alone, such as visiting a doctor’s office or shopping, because of a physical, mental, or emotional condition.


[i]The MCBS collects data from community-dwelling and institutionalized beneficiaries. Because barriers to preventive care are different for the two populations, this analysis restricted to community-dwelling beneficiaries.

References

  1. Maciosek, Michael V., Ashley B. Coffield, Nichol M. Edwards, Thomas J. Flottemesch, Michael J. Goodman, and Leif I. Solberg. “Priorities among effective clinical preventive services: results of a systematic review and analysis.” American Journal of Preventive Medicine 31, no. 1 (2006): 52-61.
  2. Weedon-Fekjær, Harald, Pål R. Romundstad, and Lars J. Vatten. “Modern mammography screening and breast cancer mortality: population study.” Bmj 348 (2014): g3701.
  3. Fireman, Bruce, Janelle Lee, Ned Lewis, Oliver Bembom, Mark Van Der Laan, and Roger Baxter. “Influenza vaccination and mortality: differentiating vaccine effects from bias.” American Journal of Epidemiology 170, no. 5 (2009): 650-656.
  4. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 10 Leading Causes of Death by Age Group, United States – 2013, https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2013-a.pdf (accessed November 21, 2016).
  5. American Cancer Society. Breast Cancer Facts & Figures 2013-2014. Atlanta: American Cancer Society, Inc. 2013. (accessed March 5, 2016).
  6. Centers for Disease Control and Prevention, and National Cancer Institute, United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report, 2016, https://nccd.cdc.gov/uscs/ (accessed November 21, 2016).
  7. Diab, Marguerite E., and Mark V. Johnston. “Relationships between level of disability and receipt of preventive health services.” Archives of Physical Medicine and Rehabilitation 85, no. 5 (2004): 749-757.
  8. Kroll, Thilo, Gwyn C. Jones, Matthew Kehn, and Melinda T. Neri. “Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry.” Health & Social Care in the Community 14, no. 4 (2006): 284-293.
  9. Sanchez, Jill, Gretchen Byfield, Traci Tymus Brown, Kathryn LaFavor, Donna Murphy, and Prakash Laud. “Perceived accessibility versus actual physical accessibility of healthcare facilities.” Rehabilitation Nursing 25, no. 1 (2000): 6-9.
  10. Horner-Johnson, Willi, Konrad Dobbertin, Jae Chul Lee, and Elena M. Andresen. “Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.” Health Services Research 49, no. 6 (2014): 1980-1999.
  11. Wei, Wenhui, Patricia A. Findley, and Usha Sambamoorthi. “Disability and receipt of clinical preventive services among women.” Women’s Health Issues 16, no. 6 (2006): 286-296.
  12. U.S. Department of Health and Human Services. Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status, 2011, https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status (accessed November 21, 2016).
  13. Erickson, William, Camille Lee, and Sarah von Schrader. “Disability statistics from the 2008 American community survey (ACS).” Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC) (2010).



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