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Creation of New Race-Ethnicity Codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries

Final Report

This project continued an earlier one in order to identify disparities in the use of Medicare services. This project created and validated a measure of socioeconomic status (SES) and compiled tabulations in the use of selected Medicare services by race and ethnicity and SES nationally and within the largest metropolitan statistical areas (MSAs) in which elderly Hispanics and Asians reside.

RTI International prepared this report for the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) under CMS Contract No. 500-00-0024.

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By Arthur J. Bonito, Ph.D.; Carla Bann, Ph.D.; Celia Eicheldinger, M.S.; Lisa Carpenter, B.S.

Table of Contents

Executive Summary
1. Introduction
  1.1 Background
  1.2 Purpose
  1.3 Objectives
  1.4 Organization of This Report
2. Methods and Data
  2.1 Improving the Race/Ethnicity Coding of Medicare Beneficiaries
  2.2 Development of the Algorithm
  2.3 Assessment of the Algorithm
  2.4 Using the Algorithm to Provide an Improved Race/Ethnicity Variable
  2.5 Geocoding Beneficiary Addresses to Link SES Data from the Census to the Beneficiaries in the EDB
     2.5.1 Address Cleaning
     2.5.2 Running the GeoCode program
     2.5.3 Summary of GeoCode program accuracy codes
     2.5.4 Application of the GeoCode Program Processing to the Full EDB
     2.5.5 Results of Geo-coding the Sample of 1.96 Million Medicare Beneficiaries
  2.6 Selection of a Sample of 1.96 Million Medicare Beneficiaries from the EDB
  2.7 Identifying the Top 10 Metropolitan Statistical Areas (MSAs) for Asian/Pacific Islander and Hispanic Elderly Population
3. Creating and Validating An Index of Socioeconomic Status
  3.1 Introduction
  3.2 Prior Work As The Starting Point
  3.3 Development of the SES Index
  3.4 Validation of the SES Measure
  3.5 Association of Clinical Measures with SES Index and SSA Measures
4. Producing Requested Tabular Analyses Incorporating the SES Measure
  4.1 Overview
  4.2 Tabulation Format
  4.3 Data Sources
  4.4 Tabulation Contents
5. Conduct of Limited Multivariate Logistic Regression Analyses
  5.1 Introduction
  5.2 The Approach
  5.3 Modeling to Assess the Impact of SES
  5.4 Modeling to Establish Racial/Ethnic Health Care Disparities
  5.5 Impact of SES on Differences in Estimated Percent Utilization
  5.6 Impact of Adding an SES-Race/Ethnicity Interaction Term to the Model
  5.7 Conclusions from the Modeling


We want to acknowledge the contributions to the work performed in this report of our programmer Ann Larsen; our primary word processor for the tabular appendices, Joyce Clay-Brooks; Loraine Monroe the word processor for the final report; and our technical editor, Marceline Murawski. Without their special skills, commitment, and hard work, this report would not have been completed on time. We also want to acknowledge the helpful comments, interest, and support of Barbara Crawley, the primary CMS Project Officer.

Federal Project Officers were Barbara Crawley, M.S., and Elizabeth Goldstein, Ph.D. (CMS) and Linda G. Greenberg, Ph.D. (AHRQ).

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AHRQ Publication Number 08-0029-EF
Current as of January 2008

Internet Citation:

Creation of New Race-Ethnicity Codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries. Final Report. AHRQ Publication No. 08-0029-EF, January 2008, Agency for Healthcare Research and Quality, Rockville, MD.


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