Medical care costs for diabetes associated with health disparities among adult Medicaid enrollees in North Carolina.

BACKGROUND: Health disparities for many diseases are large and long-standing in North Carolina and the nation. This study examines medical care costs for diabetes associated with health disparities among adults (age, > or =78 years) enrolled in Medicaid in North Carolina during state fiscal year (SFY) 2007-2008 (i.e., July 7, 2007, through June 30, 2008). METHODS: North Carolina Medicaid paid claims and enrollment data were used to calculate the prevalence of and medical care expenditures for diabetes among adult Medicaid enrollees overall and by white, African American, and American Indian race. The impacts of racial and economic health disparities on medical care costs for diabetes were determined by first calculating the proportionate differences between the diabetes prevalence for whites, African Americans, and American Indians enrolled in Medicaid and the diabetes prevalence among all whites in North Carolina. Then it was assumed that medical care costs for white, African American, and American Indian Medicaid recipients could be reduced by the same proportion if the overall prevalence among whites was achieved. RESULTS: The diabetes prevalence among adult Medicaid enrollees was 75.7%, compared with 9.1% for all North Carolina adults. During SFY 2007-2008, the state Medicaid program in North Carolina spent $525 million for diabetes-related medical care and prescription drugs among adults. An estimated $225 million in diabetes-related expenditures could be saved each year by the North Carolina Medicaid program if both racial and economic disparities in the diabetes prevalence were eliminated. LIMITATIONS: We did not have data on non-Medicaid paid health care expenditures for the Medicaid enrollees in our study. The costs of interventions to eliminate health disparities associated with diabetes are not included in the calculation of the potential savings. CONCLUSIONS: The diabetes prevalence in the Medicaid population is much greater than that for all North Carolinians, and the Medicaid costs associated with this elevated prevalence are large. North Carolina health-policy makers and health-program managers should carefully evaluate investments in interventions to reduce these race- and economic-based differences in diabetes prevalence, which could potentially reduce Medicaid costs.

Relationship between body mass index and medical care expenditures for North Carolina adolescents enrolled in Medicaid in 2004.

INTRODUCTION: Many studies document that overweight and obese adults have substantially higher medical care expenditures than do adults of normal weight, but comparable data for children or adolescents are few. This study examines patterns of expenditure for medical care and use of medical care services among a sample of North Carolina adolescents enrolled in Medicaid, stratified by body mass index categories. METHODS: North Carolina public health records, which include clinically measured height and weight, were linked to 2004 North Carolina Medicaid enrollment records to find adolescents aged 12-18 years whose records matched. We then examined all paid claims for 2004 of the 3528 adolescents whose records matched. Total expenditures by sex and race, hospital costs, physician costs, and prescription drug costs were tabulated and stratified by body mass index. We also examined, by body mass index, the percentage of adolescents who had a paid claim for selected diagnosed health conditions. RESULTS: Overall, and for most demographic and service categories, overweight adolescents and at-risk-for-overweight adolescents had higher average Medicaid expenditures than did normal-weight adolescents. Some of these differences were statistically significant. Overweight adolescents were significantly more likely to have a paid claim for services related to diabetes, asthma, or other respiratory conditions. CONCLUSION: Although based on a small sample, our results suggest that overweight has negative health consequences as early as adolescence. Further studies with larger samples could help confirm the findings of our study.

Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004.

OBJECTIVES: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0-19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. METHODS: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. RESULTS: 1,914 children ages 0-19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0-19. CONCLUSIONS: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.

Racial disparities in birth outcomes increase with maternal age: recent data from North Carolina.

BACKGROUND: Racial disparities in birth outcomes persist in North Carolina and the United States. We examined patterns of birth outcomes and womens health measures in North Carolina by race and age to portray the largest disparities. We wanted to see if our data were consistent with the "weathering hypothesis," which holds that the health of African American women may begin to deteriorate in early adulthood, with negative effects on birth outcomes. METHODS: We conducted a descriptive analysis of 1999-2003 North Carolina live birth and infant death records and 2001-2003 Behavioral Risk Factor Surveillance System survey data. Birth outcome measures examined were low birth weight, very low birth weight, infant mortality neonatal mortality and postneonatal mortality. Womens health measures examined were obesity self-reported health status, high blood pressure, high cholesterol, current smoking, and smoking during pregnancy. Rates for whites and African Americans were compared for each of three age groups. RESULTS: Racial disparities in birth outcomes increase with increasing maternal age. African American teens often experience better birth outcomes than older African American women. Racial disparities in measures of womens health also increase with increasing age. CONCLUSIONS: Health problems among older African American women of reproductive age may contribute substantially to racial disparities in birth outcomes. Improving the health of older African American women may be an effective strategy to reduce the overall racial disparities in birth outcomes.

Discrepancies between published data on racial classification and self-reported race: evidence from the 2002 North Carolina live birth records.

OBJECTIVES: We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. METHODS: We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. RESULTS: Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as "Other" race, but nearly all of these births are re-coded to "white" for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. CONCLUSIONS: This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated.

A review of available data on the health of the Latino population in North Carolina.

OBJECTIVE: To portray major health problems and conditions in the Latino population of North Carolina. STUDY DESIGN: Presentation of descriptive information from North Carolina data sets on Latino health issues, with whites and African Americans as comparison groups. DATA SOURCES/STUDY SETTING: Statewide data on the health of the Latino population are provided from the following data sets: North Carolina Behavioral Risk Factor Surveillance System (BRFSS), death certificates, North Carolina Office of the Chief Medical Examiner records, sexually transmitted disease reports, reported pregnancies, certificates of live birth, North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), and North Carolina Birth Defects Monitoring Program (BDMP) cases. DATA COLLECTION METHODS: Review of existing data systems. PRINCIPAL FINDINGS: Latinos in North Carolina have high death rates from motor vehicle injuries and homicide. Latinos who die from unintentional injuries, homicide, and suicide are much more likely than whites or African Americans to have a high blood alcohol level. Latinos are less likely than other groups to have health insurance. Latinos have much higher pregnancy rates, both for teens and older women, and are more likely to begin prenatal care late or have no prenatal care. Rates of sexually transmitted disease are higher than those for whites but lower than those for African Americans. Latinos are more likely to initiate breastfeeding. Latinos have a higher rate of neural tube defects compared to the other groups, while being less likely to take folic acid every day before pregnancy. Despite lower family incomes, later entry into prenatal care, and higher rates of certain birth defects, Latinos had the lowest rates of low birth weight and infant mortality. Lower rates of smoking during pregnancy among Latinos may partially account for the better birth outcomes. CONCLUSIONS: Many of the health issues among Latinos in North Carolina are consistent with the fact that they are a very young, mainly recently-arrived, immigrant population with more males than females. RELEVANCE: These findings may provide a basis for designing more effective health improvement programs for the Latino population of North Carolina.