Rapid increases in the numbers and proportions of elderly in the U.S. have lead to concerns about the impact of these changes on use of health services and the burden of chronic disease. To determine the health care utilization patterns among elderly asthmatics in the Upstate New York area.
Outpatient health care utilization patterns were determined using Medicare claims data in 45 counties in upstate New York from 9/1/01 – 8/31/02 using the International Classification of Diseases code of 493 for asthma. Medicare is the major health insurance provider for this age group so the prevalence of asthma based on outpatient claims was calculated for the different counties using the population census data.
There were 67,000 claims that met this criteria. Using this set of claims the corresponding beneficiary and patient ID numbers were identified. There were 27,669 unique identifiers in this set. From the table of patient information, the zip code for each patient was extracted and it was used to identify which county the patient lived in, and this allowed the data to be summarized by county prevalence. The gender distribution among asthmatics showed a preponderance of female gender, 67% versus 33% male. Only 9,884 (36%) had spirometry performed. 3,462 out of the 27,669 with asthma also had claims for heart failure showing the increased prevalence of co-morbidities in this population.CONCLUSIONS: Spirometry claims suggest under use of objective testing in a cohort that needs it the most, given the comorbidities that make diagnosis and management of asthma a challenge in the elderly.
Major problems with identifying asthma in the elderly include a low index of suspicion by physicians, under use of spirometry and the high frequency of co-morbid diseases which have similar signs and symptoms which probably contribute to the under diagnosis and under treatment of asthma.
A. Mishra, None.