STATISTICAL BRIEF #5: Medical Care and Treatment for Chronic Conditions, 2000
2002
By: Marie N. Stagnitti, MPA
Introduction
The quality of the health care received by Americans is an issue of public policy concern for several reasons. First, the level of quality of the health care delivery system affects the capacity to provide timely, accessible, effective and efficient medical care to the population in need of services. Secondly, estimates of quality are vital to evaluate the costs and outcomes of health care delivery and to help identify potential areas where improvements are necessary. Finally, all components of the population may not be receiving care equally. Following these population subgroups over time can provide information about whether greater equity has been achieved or whether serious gaps remain. The treatment and preventive care of persons with chronic conditions is an issue of particular public policy concern. To ensure adequate access to care is available to persons with chronic conditions, it is essential to know how many persons suffer from such conditions, as well as the treatment regimens and preventive care they receive.
Beginning in 2000, enhancements were made to the Medical Expenditure Panel Survey (MEPS) to elicit information about the quality of health care received by the people in the United States. Questions were added to the core questionnaire to collect data pertaining to selected chronic conditions, and the course of treatment and preventive care taken for such conditions. A self-administered questionnaire ascertaining information about the health care and screening tests received by persons with diabetes was also added. This MEPS statistical brief presents preliminary analyses of the treatment regimens for individuals with selected chronic conditions based on data from the 2000 MEPS. Medical care/treatment for persons 18 or older with diabetes, cardiovascular disease, asthma, stroke, and high blood pressure are examined (all coverage estimates based on health insurance status for the first part of 2000). All results discussed in this statistical brief are statistically significant at the 0.05 level. Standard errors for tables are provided following the tables.
Highlights
Likelihood of selected chronic conditions
Overall, 10.3 percent of the U.S. civilian noninstitutionalized population age 18 or older reported having heart disease, 23.0 percent reported having high blood pressure, 9.1 percent reported having asthma, and 6.2 percent reported having diabetes (Table 1). In addition, the population age 65 and over had a significantly higher likelihood of having reported heart disease, high blood pressure and diabetes relative to those age 18 to 64. Hispanics 18 or older were less likely than blacks, or whites and persons of other races to have reported heart disease (5.1 percent, 8.9 percent and 11.2 percent, respectively). This pattern also held for those 18 or older that reported having high blood pressure (15.2 percent, 27.5 percent, and 23.4 percent, respectively), as well as those reported having asthma (7.2 percent, 9.7 percent, and 9.3 percent, respectively) (Figure 1). Whites and persons of other races 18 and older were more likely to have reported heart disease (11.2 percent) than blacks (8.9 percent), whereas blacks 18 and older were more likely to have reported high blood pressure (27.5 percent) than whites and persons of other races (23.4 percent). Hispanics and blacks 18 or older were more likely to have reported diabetes (7.3 percent and 8.9 percent, respectively) than whites and persons of other races (5.6 percent).
Table 1 also shows persons 18 or older with public insurance only were more likely to have reported having heart disease (23.0 percent), high blood pressure (42.7 percent), asthma (13.0 percent), and diabetes (13.6 percent) than individuals with any private insurance and the uninsured (heart disease 9.0 and 5.2 percent, respectively; high blood pressure 21.5 and 13.2 percent, respectively; asthma 8.7 and 7.9, respectively; and diabetes 5.3 and 3.7 percent, respectively). Those 18 and older with any private insurance were more likely than those uninsured to report having heart disease (9.0 percent versus 5.2 percent), high blood pressure (21.5 percent versus 13.2 percent) and diabetes (5.3 percent versus 3.7 percent).
Medical care for individuals with diabetes
In 2000, 69.4 percent of diabetics aged 18 or older reported having had a Hemoglobin A1c test and 62.8 percent reported having had their feet checked for sores or irritations. For the time period covering 2000 through early 2001, 65.9 percent reported having an eye exam in which their pupils were dilated (Table 2). It was also noted that Hispanics age 18 or older with diabetes were less likely than blacks, as well as whites and individuals of other races to have had a routine check-up within the past 12 months (79.7 percent versus 91.7 percent and 87.9 percent, respectively).
Uninsured individuals with diabetes between the ages of 18 to 64 were less likely than the privately insured to report having had a Hemoglobin A1c test during 2000 (61.7 percent versus 78.5 percent) (Figure 2). Uninsured individuals aged 18 to 64 with diabetes were also less likely than the privately insured to report having had their feet checked for sores or irritations in 2000 (48.4 percent versus 65.1 percent) or to report having had a routine check-up within the past 12 months (75.0 percent versus 88.1 percent). Furthermore, uninsured persons age 18-64 with diabetes were less likely than those with private insurance or those with public coverage only to report having their pupils dilated in an eye exam which occurred between 2000 through early 2001 (48.9 percent versus 63.8 percent and 67.5 percent, respectively).
Treatment regimens for individuals with asthma
The measures under consideration for asthma treatment were prescribed medication utilization, use of a steroid inhaler, and having a peak flow meter at home. Table 3 indicates that 47.9 percent of all asthmatics age 18 or older reported taking prescribed medicines, 29 percent reported using steroid inhalers, and 17 percent reported having a peak flow meter in their home.
Lifestyle advice from healthcare providers and frequency of routine medical exams for persons with cardiovascular disease or stroke
Table 4 illustrates that for persons age 65 and older with heart disease, the likelihood of getting a blood pressure check in the past year was somewhat higher than those age 18-64 (98.6 versus 92.9 percent). Similarly, the age 65 and older population with heart disease were more likely to have had a routine check-up in the past 12 months (89.2 percent versus 75.3 percent) or to have been counseled by a healthcare professional to moderate their diet (64.7 percent versus 57.2 percent) (Figure 3).
Nearly 97 percent (96.5 percent) of persons 18 or older who reported having a stroke reported having their blood pressure checked in the past year, and close to 60 percent were told to moderate their diet (59.1 percent) or increase their level of physical activity (58.7 percent). Persons age 18-64 reporting having a stroke were less likely to have a routine check-up within the past 12 months (73.4 percent) than those age 65 and older (86.8 percent).
About MEPS
The Medical Expenditure Panel Survey (MEPS) is conducted to provide nationally representative estimates of health care use, expenditures, sources of payment, and insurance coverage for the U.S. civilian non-institutionalized population. MEPS is sponsored by the Agency for Healthcare Research and Quality (AHRQ). More information about MEPS can be obtained from the MEPS web site at http://www.meps.ahrq.gov/ or by calling the MEPS Project Director at (301) 594-1406.
Table 1: Percent of persons 18 or older with selected chronic conditions by demographic characteristics and health insurance status, 2000
Population characteristics
Total population (number of persons in 000's)
Percent with heart disease*
Percent with high blood pressure
Percent with asthma
Percent with diabetes
Total
200926
10.3
23.0
9.1
6.2
Age
Age 18-64
167995
6.2
17.0
9.2
4.4
65 and older
32930
31.1
53.8
8.5
15.4
Race/Ethnicity and Age
White and other
156924
11.2
23.4
9.3
5.6
Age 18-64
128540
6.6
17.0
9.5
4.0
65 and older
28384
31.6
52.4
8.5
13.3
Black
22921
8.9
27.5
9.7
8.9
Age 18-64
20144
6.0
22.0
9.9
6.3
65 and older
2777
29.4
66.9
8.3
27.8
Hispanic
21081
5.1
15.2
7.2
7.3
Age 18-64
19311
3.2
11.6
6.9
5.4
65 and older
1769
24.9
54.8
10.2
28.6
Sex and Age
Male
95174
10.7
22.4
7.5
6.0
Age 18-64
81340
6.3
17.8
7.8
4.4
65 and older
13834
36.2
49.9
5.8
15.9
Female
105751
9.9
23.5
10.6
6.3
Age 18-64
86655
6.0
16.3
10.6
4.4
65 and older
19096
27.4
56.5
10.5
15.0
Health Insurance and Age
Any private
140227
9.0
21.5
8.7
5.3
Age 18-64
122610
5.8
17.1
8.9
4.1
65 and older
17616
31.3
52.3
7.5
14.1
Public only
27357
23.0
42.7
13.0
13.6
Age 18-64
12269
13.0
26.9
16.8
9.5
65 and older
15088
31.1
55.6
9.8
17.0
Uninsured
33342
5.2
13.2
7.9
3.7
Age 18-64
33116
5.2
13.1
7.9
3.7
65 and older
--
--
--
--
--
* Combines coronary heart disease, angina, myocardial infarction and other heart disease diagnoses.
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Note: The diabetes population for Table 1 is based on answering "yes" to a question in the Priority Conditions section of the MEPS questionnaire, whereas the diabetes population for Table 2 is based on completing the self administration of the MEPS Diabetes Care Supplement.
Numbers may not add to totals due to rounding.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Table 2: Number of persons 18 or older with diabetes by selected demographic characteristics and insurance status, and percent with specific medical examinations and routine check-ups, 2000
Population characteristics
Total population (number of persons in 000's)
Percent who had Hemoglobin A1c test
Percent who had feet checked for sores or irritations
Percent who had an eye exam in which pupils were dilated**
Percent with routine check-up within past 12 months
Total
12306
69.4
62.8
65.9
87.5
Age
Age 18-64
7223
74.1
61.5
62.0
85.5
65 and older
5082
62.8
64.7
71.5
90.4
Race/ Ethnicity and Age
White and other
8741
71.1
64.5
67.5
87.9
Age 18-64
4910
77.5
64.0
63.2
85.7
65 and older
3831
62.8
65.1
73.0
90.7
Black
2029
62.6
56.0
64.7
91.7
Age 18-64
1288
63.5
53.1
60.8
90.5
65 and older
--
--
--
--
--
Hispanic
1536
69.2
62.6
58.5
79.7
Age 18-64
1025
71.1
60.3
57.7
78.4
65 and older
--
--
--
--
--
Sex and Age
Male
5565
70.2
65.9
68.3
88.6
Age 18-64
3344
75.7
64.5
64.1
86.6
65 and older
2221
61.8
67.9
74.5
91.6
Female
6741
68.8
60.4
64.0
86.6
Age 18-64
3879
72.7
59.0
60.2
84.6
65 and older
2861
63.6
62.2
69.1
89.3
Health Insurance and Age
Any private
7444
73.3
65.4
66.7
89.6
Age 18-64
4940
78.5
65.1
63.8
88.1
65 and older
2504
63.0
66.0
72.4
92.8
Public only
3700
64.3
62.4
69.6
87.2
Age 18-64
1127
67.8
59.5
67.5
85.3
65 and older
2572
62.7
63.6
70.5
88.0
Uninsured
1162
61.4
48.1
49.2
75.2
Age 18-64
1156
61.7
48.4
48.9
75.0
65 and older
--
--
--
--
--
** Percentages in this column include those having an eye exam in 2000 through the early part of 2001.
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Note: The diabetes population for Table 1 is based on answering "yes" to a question in the Priority Conditions section of the MEPS questionnaire, whereas the diabetes population for Table 2 is based on completing the MEPS Diabetes Care Supplement.
Numbers may not add to totals due to rounding.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Table 3: Number of persons 18 or older with asthma by selected demographic characteristics and insurance status, and percent with specific treatments and routine check-ups, 2000
Population characteristics
Population (number of persons in 000's)
Percent that take prescription medicines for asthma
Percent that use steroid inhaler for asthma
Percent that have peak flow meter at home
Percent with routine check-up within past 12 months
Total
18322
47.9
29.0
17.0
64.0
Age
Age 18-64
15511
46.5
27.6
16.1
59.3
65 and older
2811
55.8
36.9
21.7
90.0
Race/Ethnicity and Age
White and other
14571
47.2
28.6
16.1
62.5
Age 18-64
12172
45.6
27.0
15.1
57.1
65 and older
2399
55.6
36.6
21.5
89.9
Black
2231
51.4
30.4
19.5
67.0
Age 18-64
2000
50.3
28.8
20.2
64.3
65 and older
--
--
--
--
--
Hispanic
1520
49.7
31.2
21.8
74.2
Age 18-64
1339
49.4
30.8
20.0
72.0
65 and older
--
--
--
--
--
Sex and Age
Male
7156
36.8
22.0
12.1
53.6
Age 18-64
6353
33.9
19.9
11.1
49.0
65 and older
--
--
--
--
--
Female
11166
55.1
33.5
20.1
70.7
Age 18-64
9158
55.3
32.9
19.6
66.4
65 and older
2008
54.3
36.3
22.3
90.0
Health Insurance and Age
Insured
15701
49.0
29.5
17.4
65.7
Age 18-64
12906
47.6
27.9
16.5
60.4
65 and older
2795
55.6
36.8
21.5
90.1
Uninsured
2621
41.4
26.2
14.8
54.0
Age 18-64
2605
41.0
26.0
14.6
53.8
65 and older
--
--
--
--
--
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Numbers may not add to totals due to rounding.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Table 4: Percent of persons 18 or older with cardiovascular conditions obtaining lifestyle advice or routine medical exams from healthcare providers, 2000
Population characteristics
Population (number of persons in 000's)
Percent with blood pressure check within past 12 months
Percent told to moderate diet
Percent told to increase exercise
Percent with routine check-up within past 12 months
Reported Condition and Age
Heart disease*
20596
95.7
60.9
62.0
82.2
Age 18-64
10364
92.9
57.2
60.5
75.3
65 and older
10232
98.6
64.7
63.6
89.2
Stroke
4895
96.5
59.1
58.7
81.9
Age 18-64
1802
94.3
52.6
55.5
73.4
65 and older
3093
97.8
62.9
60.5
86.8
* Combines coronary heart disease, angina, myocardial infarction and other heart disease diagnoses.
Numbers may not add to totals due to rounding.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Standard errors to accompany Table 1: Percent of persons 18 or older with selected chronic conditions by demographic characteristics and health insurance status, 2000
Population characteristics
Percent with heart disease*
Percent with high blood pressure
Percent with asthma
Percent with diabetes
Total
0.33
0.55
0.24
0.26
Age
Age 18-64
0.26
0.48
0.30
0.23
65 and older
1.10
1.20
0.79
0.82
Race/Ethnicity and Age
White and other
0.38
0.60
0.27
0.28
Age 18-64
0.29
0.52
0.36
0.26
65 and older
1.23
1.30
0.83
0.87
Black
0.79
1.38
0.93
0.83
Age 18-64
0.62
1.28
1.02
0.70
65 and older
2.98
3.03
1.90
2.42
Hispanic
0.47
0.90
0.61
0.55
Age 18-64
0.39
0.79
0.65
0.53
65 and older
3.11
3.89
2.15
2.97
Sex and Age
Male
0.39
0.64
0.38
0.35
Age 18-64
0.34
0.61
0.43
0.32
65 and older
1.41
1.66
0.84
1.27
Female
0.48
0.70
0.36
0.32
Age 18-64
0.39
0.59
0.44
0.27
65 and older
1.39
1.50
1.10
0.97
Health Insurance and Age
Any private
0.36
0.58
0.31
0.29
Age 18-64
0.29
0.52
0.35
0.28
65 and older
1.49
1.55
0.85
1.13
Public only
0.98
1.30
0.84
0.88
Age 18-64
1.03
1.50
1.18
1.09
65 and older
1.33
1.71
1.14
1.19
Uninsured
0.55
0.71
0.67
0.37
Age 18-64
0.52
0.72
0.67
0.37
65 and older
--
--
--
--
* Combines coronary heart disease, angina, myocardial infarction and other heart disease diagnoses.
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Note: The diabetes population for Table 1 is based on answering "yes" to a question in the Priority Conditions section of the MEPS questionnaire, whereas the diabetes population for Table 2 is based on completing the self administration of the MEPS Diabetes Care Supplement.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Standard errors to accompany Table 2: Number of persons 18 or older with diabetes by selected demographic characteristics and insurance status, and percent with specific medical examinations and routine check-ups, 2000
Population characteristics
Percent who had Hemoglobin A1c test
Percent who had feet checked for sores or irritations
Percent who had an eye exam in which pupils were dilated**
Percent with routine check-up within past 12 months
Total
1.60
1.69
1.81
1.41
Age
Age 18-64
1.97
2.26
2.48
1.77
65 and older
2.61
2.64
2.74
1.77
Race/ Ethnicity and Age
White and other
1.85
2.36
2.28
1.83
Age 18-64
2.53
2.95
2.90
2.34
65 and older
3.09
3.34
3.21
2.30
Black
4.43
4.27
4.69
2.27
Age 18-64
6.22
6.52
6.14
2.93
65 and older
--
--
--
--
Hispanic
3.54
4.01
4.05
3.51
Age 18-64
4.20
5.18
5.25
4.26
65 and older
--
--
--
--
Sex and Age
Male
2.62
2.25
2.88
1.73
Age 18-64
3.24
3.03
3.60
2.46
65 and older
4.26
3.29
4.27
2.38
Female
1.97
2.34
2.13
1.78
Age 18-64
2.27
3.26
3.01
2.11
65 and older
3.56
3.70
3.09
2.49
Health Insurance and Age
Any private
2.10
2.33
2.35
1.56
Age 18-64
2.62
2.58
2.95
1.89
65 and older
3.62
4.22
3.95
1.87
Public only
2.83
2.99
2.90
2.41
Age 18-64
5.26
5.57
4.32
4.92
65 and older
3.67
3.67
3.73
2.63
Uninsured
5.02
5.85
6.17
4.51
Age 18-64
5.04
5.89
6.18
4.53
65 and older
--
--
--
--
** Percentages in this column include those having an eye exam in 2000 through the early part of 2001.
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Note: The diabetes population for Table 1 is based on answering "yes" to a question in the Priority Conditions section of the MEPS questionnaire, whereas the diabetes population for Table 2 is based on completing the MEPS Diabetes Care Supplement.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Standard errors to accompany Table 3: Number of persons 18 or older with asthma by selected demographic characteristics and insurance status, and percent with specific treatments and routine check-ups, 2000
Population characteristics
Percent that take prescription medicines for asthma
Percent that use steroid inhaler for asthma
Percent that have peak flow meter at home
Percent with routine check-up within past 12 months
Total
1.72
1.36
1.26
1.63
Age
Age 18-64
1.88
1.37
1.35
1.75
65 and older
3.89
3.93
3.10
2.24
Race/Ethnicity and Age
White and other
2.03
1.61
1.32
1.86
Age 18-64
2.25
1.61
1.48
1.97
65 and older
4.37
4.50
3.47
2.51
Black
3.43
3.55
4.05
3.86
Age 18-64
3.76
3.65
4.43
4.22
65 and older
--
--
--
--
Hispanic
4.73
3.82
4.32
4.19
Age 18-64
5.02
4.12
4.43
4.62
65 and older
--
--
--
--
Sex and Age
Male
2.43
2.01
1.58
2.45
Age 18-64
2.60
2.05
1.56
2.67
65 and older
--
--
--
--
Female
1.97
1.64
1.82
1.92
Age 18-64
2.26
1.79
2.11
2.18
65 and older
4.34
4.42
3.44
2.61
Health Insurance and Age
Insured
1.97
1.55
1.26
1.84
Age 18-64
2.20
1.58
1.36
1.99
65 and older
3.92
3.95
3.10
2.25
Uninsured
3.80
3.23
3.04
3.76
Age 18-64
3.82
3.26
3.05
3.77
65 and older
--
--
--
--
-- Cell size under 100 observations or standard error equal to or greater than 30 percent.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000.
Standard errors to accompany Table 4: Percent of persons 18 or older with cardiovascular conditions obtaining lifestyle advice or routine medical exams from healthcare providers, 2000
Population characteristics
Percent with blood pressure check within past 12 months
Percent told to moderate diet
Percent told to increase exercise
Percent with routine check-up within past 12 months
Reported Condition and Age
Heart disease*
0.57
1.24
1.60
1.22
Age 18-64
1.11
1.87
1.94
1.68
65 and older
0.39
1.66
2.33
1.52
Stroke
0.94
2.99
2.65
2.45
Age 18-64
1.84
5.53
5.15
4.33
65 and older
1.03
3.41
3.28
3.04
* Combines coronary heart disease, angina, myocardial infarction and other heart disease diagnoses.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000.
Figure 1. Percent of persons 18 or older with heart disease, high blood pressure, asthma, and diabetes by race/ethnicity
Race/ethnicity
Hispanic
Black
White and Other
Heart Disease
5.1%
8.9%
11.2%
High Blood Pressure
15.2%
27.5%
23.4%
Asthma
7.2%
9.7%
9.3%
Diabetes
7.3%
8.9%
5.6%
Hispanics 18 or older were less likely than blacks, or whites and persons of other races to report having heart disease, high blood pressure, or asthma.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 2. Percent of persons age 18-64 with diabetes that had selected medical care examinations by insurance status, 2000
Insurance status
Any Private
Public Only
Uninsured
Hemoglobin AIC Test
78.5%
67.8%
61.7%
Feet Checked
65.1%
59.5%
48.4%
Routine Check-up Within Past 12 Months
88.1%
85.3%
75.0%
In 2000, uninsured persons age 18-64 with diabetes were less likely than persons with any private insurance to have reported having a Hemoglobin A1c test, their feet checked for sores/irritations, or a routine check-up within the past 12 months.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
Figure 3. Percent of persons 18 or older with heart disease obtaining lifestyle advice or routine medical exams from healthcare providers within the past 12 months by age, 2000
Age
Age 18-64 With Heart Disease
Age 65 And Older With Heart Disease
Blood Pressure Check
92.9%
98.6%
Moderate Diet
57.2%
64.7%
Increase Exercise Activity
60.5%
63.6%
Routine Check-Up
75.3%
89.2%
In 2000, those age 18-64 with heart disease were less likely to have a blood pressure check within the past 12 months to be advised to moderate their diet, or have a routine check-up within the past 12 months than those age 65 and older.
Source: Center for Cost and Financing Studies, AHRQ, Medical Expenditure Panel Survey, 2000
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