192699 Disparities in major joint replacement surgery among insureds with AARP Medicare supplement coverage underwritten by Unitedhealh Group

Sunday, November 8, 2009

Kevin Hawkins, PhD , Ingenix, Brooklyn, MI
Kamisha Hamilton Escoto, PhD , Ingenix Consulting, Ingenix, Eden Prairie, MN
Ronald J. Ozminkowski, PhD , Health Care Innovation and Information, Ingenix, Ann Arbor, MI
Gandhi Bhattarai, PhD , Ingenix, Rocky Hill, CT
Richard Migliori, MD , UnitedHealth Group Alliances, Minnetonka, MN
Research Objective: Determine if disparities in hip and knee replacement surgery exist among osteoarthritis patients with Medicare Supplement (i.e., Medigap) coverage.

Study Design: Data were obtained from United Health Group's database of insureds who have Medigap coverage via AARP Medicare Supplement insurance. Patients were selected for the study if they had one or more medical claims with a diagnosis of osteoarthritis from July 1, 2006-June 30, 2007. Logistic regression analyses tested for age-, gender-, race-, or income-related differences in the likelihood of receiving a hip or knee replacement surgery. The regression models controlled for socioeconomics, health status, type of supplement plan, and residential location.

Population Studied: Of the 2.2 million Medigap insureds who were eligible for the study, 529,652 (24%) had osteoarthritis. Of these, 32,527 (6.1%) received a hip or knee replacement surgery.

Principle Findings: Males were 6% (p<0.001) more likely than females to have a replacement surgery. Patients residing in minority or lower-income neighborhoods were less likely to receive a hip or knee replacement surgery. The surgery rate decreased with age. Medigap plan type was not a strong predictor of the likelihood of hip or knee replacement. Disparities were much greater by comorbid condition and residential location. Obese patients were 1.79 (p<0.001) times as likely, whereas patients with COPD were only 0.69 times (p<0.001) as likely to have a hip or knee replacement. Patients in rural areas were 14% (p<0.001) less likely than those in urban areas and patients residing in South Dakota, Idaho, and Alaska were 3.24 (p<0.001), 2.58 (p<0.001), and 2.49 (p<0.001) more likely than those in New Jersey to have replacement surgery.

Conclusions: Disparities in hip and knee replacement surgery existed by age, gender, race, and income levels. Larger disparities were found by residential location and comorbid condition. UnitedHealth Group is designing interventions to address these disparities; these interventions will begin in mid-2009.

Learning Objectives:
Describe disparities in hip and knee replacement surgery among osteoarthritis patients with Medicare Supplement (i.e., Medigap) coverage.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Kevin R. Hawkins, Ph.D., Senior Director at Ingenix has over 20 years experience designing, conducting, and managing health services research. Dr. Hawkins has conducted a variety of research and evaluation projects, specifically health-economic, quality-of-life, disease burden, pharmacoeconomics and retrospective database analyses. Dr. Hawkins has authored over 40 peer-reviewed articles and presentations, and is a reviewer for several medical-scientific journals. Before joining Ingenix, Dr. Hawkins worked for IMS Health, Medstat, and Blue Cross Blue Shield of Michigan. Dr. Hawkins received his Ph.D. in Health Economics from Wayne State University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.