Disparities in Antidepressant Treatment in Medicaid Elderly Diagnosed with Depression

Authors

  • Harry S. Strothers III MD, MMM,

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • George Rust MD, MPH,

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • Patrick Minor MS,

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • Edith Fresh PhD,

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • Benjamin Druss MD, MPH,

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • David Satcher MD, PhD

    1. From the *Department of Family Medicine, and National Center for Primary Care, Morehouse School of Medicine, East Point and Atlanta, GeorgiaRollins School of Public Health, Emory University, Atlanta, Georgia.
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  • This work was supported in part by Health Care Financing Administration Contract 500-96-0023, Centers for Medicare and Medicaid Services Contract 500-01-0043, and National Institutes of Health National Center on Minority Health and Health Disparities Grant 5 P20 MD00272-02.

Harry S. Strothers III, MD, MMM, Associate Professor of Family Medicine and Geriatric Team Leader, National Center for Primary Care, Morehouse School of Medicine, 1513 E. Cleveland Avenue, Bldg #100, Suite 300-A, East Point, GA 30344. E-mail: Strothh@msm.edu

Abstract

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.

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