Persistence in health behaviors among Medicare beneficiaries
Author(s)
Bruce Stuart,
Amy Davidoff,
Francoise Pradel,
Ruth Lopert,
Thomas Shaffer,
Eberechukwu Onukwugha,
Franklin Hendrick*,
Jennifer Lloyd
Affiliation(s)
. The Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, USA.
. The Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, USA.
ABSTRACT
We examined persistence in seven common preventive health practices for a nationally representative sample of Medicare beneficiaries over 4-year observation periods. Six panels from the 1997-2005 Medicare Current Beneficiary Survey (MCBS) were used resulting in 13,913 unique individuals with ages ranging from below 65 (disabled) to over 80 years old. Persistence in behavior was defined as the proportion of the observation period beneficiaries participated in each activity. We estimated behavioral persistence as a function of baseline demographic, socioeconomic, and health characteristics using multivariate regression analysis. Beneficiaries were most persistent in smoking abstinence (81% reported not smoking) and least persistent with routine exercise (47% reporting none). From multivariate regression results, there was greater persistence among beneficiaries who were married when compared to those living alone (p < 0.01 except for weekly exercise, p < 0.05 and cholesterol screening, ns), with at least a high school education compared to no high school (p < 0.01 for weekly exercise, prostate cancer screening, pap smear, p < 0.05 for influenza vaccination and mammography, but ns for smoking cessation and cholesterol screening), and of higher income (>300% FPL compared to <100% FPL all p < 0.01). Increasing age (greater than 80 compared to 65 - 69) was associated with increased compliance in influenza vaccination and smoking cessation (p < 0.01) while negatively associated with weekly exercise and cancer screenings (p < 0.01). Medicare beneficiaries are inconsistently persistent with common preventive health practices.
We examined persistence in seven common preventive health practices for a nationally representative sample of Medicare beneficiaries over 4-year observation periods. Six panels from the 1997-2005 Medicare Current Beneficiary Survey (MCBS) were used resulting in 13,913 unique individuals with ages ranging from below 65 (disabled) to over 80 years old. Persistence in behavior was defined as the proportion of the observation period beneficiaries participated in each activity. We estimated behavioral persistence as a function of baseline demographic, socioeconomic, and health characteristics using multivariate regression analysis. Beneficiaries were most persistent in smoking abstinence (81% reported not smoking) and least persistent with routine exercise (47% reporting none). From multivariate regression results, there was greater persistence among beneficiaries who were married when compared to those living alone (p < 0.01 except for weekly exercise, p < 0.05 and cholesterol screening, ns), with at least a high school education compared to no high school (p < 0.01 for weekly exercise, prostate cancer screening, pap smear, p < 0.05 for influenza vaccination and mammography, but ns for smoking cessation and cholesterol screening), and of higher income (>300% FPL compared to <100% FPL all p < 0.01). Increasing age (greater than 80 compared to 65 - 69) was associated with increased compliance in influenza vaccination and smoking cessation (p < 0.01) while negatively associated with weekly exercise and cancer screenings (p < 0.01). Medicare beneficiaries are inconsistently persistent with common preventive health practices.
Cite this paper
Stuart, B. , Davidoff, A. , Pradel, F. , Lopert, R. , Shaffer, T. , Onukwugha, E. , Hendrick, F. and Lloyd, J. (2012) Persistence in health behaviors among Medicare beneficiaries. Open Journal of Preventive Medicine, 2, 49-58. doi: 10.4236/ojpm.2012.21008.
Stuart, B. , Davidoff, A. , Pradel, F. , Lopert, R. , Shaffer, T. , Onukwugha, E. , Hendrick, F. and Lloyd, J. (2012) Persistence in health behaviors among Medicare beneficiaries. Open Journal of Preventive Medicine, 2, 49-58. doi: 10.4236/ojpm.2012.21008.
References
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(2000) Is hypercholesterolemia a risk factor and should it be treated in the elderly? American Journal of Health Promotion, 14, 347-356. [7] Hak, E., et al. (2002) Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clinical Infectious Disease, 35, 370-377. doi:10.1086/341403 [8] Fiscella, K., Dressler, R., Meldrum, S. and Holt, K. (2007) Impact of influenza vaccination disparities on elderly mortality in the United States. Preventive Medicine, 45, 83-87. doi:10.1016/j.ypmed.2007.03.007 [9] Sambamoorthi, U. and Findley, P.A. (2005) Who are the elderly who never receive influenza immunization? Preventive Medicine, 40, 469-478. doi:10.1016/j.ypmed.2004.07.017 [10] Mark, T.L. and Paramore, L.C. (1996) Pneumococcal pneumonia and influenza vaccination: Access to and use by US Hispanic Medicare beneficiaries. American Journal of Public Health, 86, 1545-1550. doi:10.2105/AJPH.86.11.1545 [11] Bonito, A.J., Lenfestey, N.F., Eicheldinger, C., Iannacchione, V.G. and Campbell, L. (2004) Disparities in immunizations among elderly Medicare beneficiaries, 2000 to 2002. American Journal of Preventive Medicine, 27, 153-160. doi:10.1016/j.amepre.2004.04.004 [12] Xakellis, G.C. (2005) Predictors of influenza immunization in persons over age 65. The Journal of the American Board of Family Medicine, 18, 426-433. doi:10.3122/jabfm.18.5.426 [13] German, P.S., et al. (1995) Extended coverage for preventive services for the elderly: Response and results in a demonstration population. American Journal of Public Health, 85, 379-386. doi:10.2105/AJPH.85.3.379 [14] Williams, S.J., Elder, J.P., Seidman, R.L. and Mayer, J.A. (1997) Preventive services in a Medicare managed care environment. Journal of Community Health, 22, 417-434. doi:10.1023/A:1025176531596 [15] Ozminkowski, R.J., et al. (2006) Predictors of preventive service use among Medicare beneficiaries. Health Care Financing Review, 27, 5-23. [16] Chen, J.Y., Diamant, A., Pourat, N. and Kagawa-Singer, M. (2005) Racial/ethnic disparities in the use of preventive services among the elderly. American Journal of Preventive Medicine, 29, 388-395. doi:10.1016/j.amepre.2005.08.006 [17] Gilligan, T., Wang, P. and Levin, R. (2004) Racial differences in screening for prostate cancer in the elderly. Archives of Internal Medicine, 164, 1858-1864. doi:10.1001/archinte.164.17.1858 [18] Gornick, M.E., et al. (1996) Effects of race and income on mortality and use of services among Medicare beneficiaries. New England Journal of Medicine, 335, 791-799. doi:10.1056/NEJM199609123351106 [19] Parker, J., Sabogal, F. and Gerbretsadik, T. (1999) Relationship between earlier and later mammography screening—California Medicare, 1992 through 1994. The Western Journal of Medicine, 170, 25-27. [20] Shekelle, P.G., et al. (2003) Interventions that increase the utilization of medicare-funded preventive services for persons age 65 and older. RAND Corporation, Santa Monica. [21] Picone, G., Brown, D. and Sloan, F. (2004) Do routine eye exams improve vision? International Journal of Health Care Finance and Economics, 4, 43-63. doi:10.1023/B:IHFE.0000019262.27436.3d [22] Weiss, L.J. and Blustein, J. (1996) Faithful patients: the effect of long-term physician-patient relationship on the costs and use health care by older Americans. American Journal of Public Health, 86, 1742-1747. doi:10.2105/AJPH.86.12.1742 [23] de Bruijn, I.A., et al. (1997) Annually repeated influenza vaccination improves humoral responses to several influenza virus strains in healthy elderly. Vaccine, 15, 1323-1329. doi:10.1016/S0264-410X(97)00019-4 [24] Voordouw, A.C.G., et al. (2004) Annual revaccination against influenza and mortality risk in community-dwelling elderly persons. The Journal of the American Medical Association, 292, 2089-2095. doi:10.1001/jama.292.17.2089 [25] US Preventive Services Task Force (2009) Clinical guidelines for breast cancer screening. http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm [26] US Preventive Services Task Force (2009) Clinical guidelines for cervical cancer screening. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm [27] Katz, S. (1983) Assessing self maintenance: Activities of daily living, mobility and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721-726. [28] Stuart, B., Doshi, J. and Terza, J. (2009) Assessing the impact of drug use on hospital costs. Health Services Research, 44, 128-144. doi:10.1111/j.1475-6773.2008.00897.x [29] Zuckerman, I., et al. (2008) Racial and ethnic disparities in treatment of dementia among Medicare beneficiaries. The Journals of Gerontology, Series B, Psychology Sciences and Social Sciences, 63, S328-S333. [30] Simoni-Wastila, L., Zuckerman, I., Shaffer, T., Blanchette, C. and Stuart, B. (2008) Drug use patterns in severely mentally ill Medicare beneficiaries: Impact of discontinuities in drug coverage. Health Services Research, 43, 496-514. doi:10.1111/j.1475-6773.2007.00779.x [31] Gameroff, M.J. (2005) Using the proportional model for health-related outcomes: Why, when, and how with various SAS? procedures. SUGI 30 Proceedings Paper, 205-230. [32] US Preventive Services Task Force (2009) Clinical guidelines for screening for lipid disorders in adults. http://www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm [33] American Cancer Society (2009) American Cancer Society guidelines for the early detection of cancer. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED [34] US Preventive Services Task Force (2009) Clinical guidelines for prostate cancer screening. http://www.ahrq.gov/clinic/uspstf/uspsprca.htm [35] US Preventive Services Task Force (2009) Clinical guidelines for colorectal cancer screening. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm [36] Center for Medicare & Medicaid Services (2009) Medicare Current Beneficiary Survey Ric 2P. http://www.cms.hhs.gov/MCBS/Downloads/A05%20Ric%202P.pdf [37] Thorpe, K.E. and Howard, D.H. (2006) The rise in spending among Medicare beneficiaries: The role of chronic disease prevalence and changes in treatment intensity. Health Affairs (Millwood), 25, w378-w388. doi:10.1377/hlthaff.25.w378 [38] Medicare Payment Advisory Commission (2008) A databook: Healthcare spending and the medicare program. Medicare Payment Advisory Commission, Washington DC. [39] Peikes, D., Chen, A., Schore, J. and Brown, R. (2009) Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. The Journal of the American Medical Association, 301, 603-618. doi:10.1001/jama.2009.12
[1] Christmas, C. and Andersen, R.A. (2000) Exercise and older patients: Guidelines for the clinician. Journal of the American Geriatrics Society, 48, 318-324. [2] Aldana, S.G. (2001) Financial impact of health promotion programs: A comprehensive review of the literature. American Journal of Health Promotion, 15, 296-320. [3] Bean, J.F., Vora, A. and Frontera, W.R. (2004) Benefits of exercise for community-dwelling older adults. Archives of Physical Medicine and Rehabilitation, 85, S31-S42. doi:10.1016/j.apmr.2004.03.010 [4] Penedo, F.J., Schneiderman, N., Dahn, J.R. and Gonzalez, J.S. (2004) Physical activity interventions in the elderly: Cancer and comorbidity. Cancer Investigation, 22, 51-67. doi:10.1081/CNV-120027580 [5] Au, D.H., et al. (2009) The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. Journal of General Internal Medicine, 24, 457-463. doi:10.1007/s11606-009-0907-y [6] Hall, K.M. and Luepker, R.V. (2000) Is hypercholesterolemia a risk factor and should it be treated in the elderly? American Journal of Health Promotion, 14, 347-356. [7] Hak, E., et al. (2002) Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations. Clinical Infectious Disease, 35, 370-377. doi:10.1086/341403 [8] Fiscella, K., Dressler, R., Meldrum, S. and Holt, K. (2007) Impact of influenza vaccination disparities on elderly mortality in the United States. Preventive Medicine, 45, 83-87. doi:10.1016/j.ypmed.2007.03.007 [9] Sambamoorthi, U. and Findley, P.A. (2005) Who are the elderly who never receive influenza immunization? Preventive Medicine, 40, 469-478. doi:10.1016/j.ypmed.2004.07.017 [10] Mark, T.L. and Paramore, L.C. (1996) Pneumococcal pneumonia and influenza vaccination: Access to and use by US Hispanic Medicare beneficiaries. American Journal of Public Health, 86, 1545-1550. doi:10.2105/AJPH.86.11.1545 [11] Bonito, A.J., Lenfestey, N.F., Eicheldinger, C., Iannacchione, V.G. and Campbell, L. (2004) Disparities in immunizations among elderly Medicare beneficiaries, 2000 to 2002. American Journal of Preventive Medicine, 27, 153-160. doi:10.1016/j.amepre.2004.04.004 [12] Xakellis, G.C. (2005) Predictors of influenza immunization in persons over age 65. The Journal of the American Board of Family Medicine, 18, 426-433. doi:10.3122/jabfm.18.5.426 [13] German, P.S., et al. (1995) Extended coverage for preventive services for the elderly: Response and results in a demonstration population. American Journal of Public Health, 85, 379-386. doi:10.2105/AJPH.85.3.379 [14] Williams, S.J., Elder, J.P., Seidman, R.L. and Mayer, J.A. (1997) Preventive services in a Medicare managed care environment. Journal of Community Health, 22, 417-434. doi:10.1023/A:1025176531596 [15] Ozminkowski, R.J., et al. (2006) Predictors of preventive service use among Medicare beneficiaries. Health Care Financing Review, 27, 5-23. [16] Chen, J.Y., Diamant, A., Pourat, N. and Kagawa-Singer, M. (2005) Racial/ethnic disparities in the use of preventive services among the elderly. American Journal of Preventive Medicine, 29, 388-395. doi:10.1016/j.amepre.2005.08.006 [17] Gilligan, T., Wang, P. and Levin, R. (2004) Racial differences in screening for prostate cancer in the elderly. Archives of Internal Medicine, 164, 1858-1864. doi:10.1001/archinte.164.17.1858 [18] Gornick, M.E., et al. (1996) Effects of race and income on mortality and use of services among Medicare beneficiaries. New England Journal of Medicine, 335, 791-799. doi:10.1056/NEJM199609123351106 [19] Parker, J., Sabogal, F. and Gerbretsadik, T. (1999) Relationship between earlier and later mammography screening—California Medicare, 1992 through 1994. The Western Journal of Medicine, 170, 25-27. [20] Shekelle, P.G., et al. (2003) Interventions that increase the utilization of medicare-funded preventive services for persons age 65 and older. RAND Corporation, Santa Monica. [21] Picone, G., Brown, D. and Sloan, F. (2004) Do routine eye exams improve vision? International Journal of Health Care Finance and Economics, 4, 43-63. doi:10.1023/B:IHFE.0000019262.27436.3d [22] Weiss, L.J. and Blustein, J. (1996) Faithful patients: the effect of long-term physician-patient relationship on the costs and use health care by older Americans. American Journal of Public Health, 86, 1742-1747. doi:10.2105/AJPH.86.12.1742 [23] de Bruijn, I.A., et al. (1997) Annually repeated influenza vaccination improves humoral responses to several influenza virus strains in healthy elderly. Vaccine, 15, 1323-1329. doi:10.1016/S0264-410X(97)00019-4 [24] Voordouw, A.C.G., et al. (2004) Annual revaccination against influenza and mortality risk in community-dwelling elderly persons. The Journal of the American Medical Association, 292, 2089-2095. doi:10.1001/jama.292.17.2089 [25] US Preventive Services Task Force (2009) Clinical guidelines for breast cancer screening. http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm [26] US Preventive Services Task Force (2009) Clinical guidelines for cervical cancer screening. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm [27] Katz, S. (1983) Assessing self maintenance: Activities of daily living, mobility and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721-726. [28] Stuart, B., Doshi, J. and Terza, J. (2009) Assessing the impact of drug use on hospital costs. Health Services Research, 44, 128-144. doi:10.1111/j.1475-6773.2008.00897.x [29] Zuckerman, I., et al. (2008) Racial and ethnic disparities in treatment of dementia among Medicare beneficiaries. The Journals of Gerontology, Series B, Psychology Sciences and Social Sciences, 63, S328-S333. [30] Simoni-Wastila, L., Zuckerman, I., Shaffer, T., Blanchette, C. and Stuart, B. (2008) Drug use patterns in severely mentally ill Medicare beneficiaries: Impact of discontinuities in drug coverage. Health Services Research, 43, 496-514. doi:10.1111/j.1475-6773.2007.00779.x [31] Gameroff, M.J. (2005) Using the proportional model for health-related outcomes: Why, when, and how with various SAS? procedures. SUGI 30 Proceedings Paper, 205-230. [32] US Preventive Services Task Force (2009) Clinical guidelines for screening for lipid disorders in adults. http://www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm [33] American Cancer Society (2009) American Cancer Society guidelines for the early detection of cancer. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED [34] US Preventive Services Task Force (2009) Clinical guidelines for prostate cancer screening. http://www.ahrq.gov/clinic/uspstf/uspsprca.htm [35] US Preventive Services Task Force (2009) Clinical guidelines for colorectal cancer screening. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm [36] Center for Medicare & Medicaid Services (2009) Medicare Current Beneficiary Survey Ric 2P. http://www.cms.hhs.gov/MCBS/Downloads/A05%20Ric%202P.pdf [37] Thorpe, K.E. and Howard, D.H. (2006) The rise in spending among Medicare beneficiaries: The role of chronic disease prevalence and changes in treatment intensity. Health Affairs (Millwood), 25, w378-w388. doi:10.1377/hlthaff.25.w378 [38] Medicare Payment Advisory Commission (2008) A databook: Healthcare spending and the medicare program. Medicare Payment Advisory Commission, Washington DC. [39] Peikes, D., Chen, A., Schore, J. and Brown, R. (2009) Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. The Journal of the American Medical Association, 301, 603-618. doi:10.1001/jama.2009.12