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J Am Geriatr Soc. 2005 Mar;53(3):456-61.

Disparities in antidepressant treatment in Medicaid elderly diagnosed with depression.

Author information

  • 1Department of Family Medicine, Morehouse School of Medicine, East Point and Atlanta, Georgia, USA. 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.

Comment in

PMID:
15743289
[PubMed - indexed for MEDLINE]
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