Ethnoracial Disparities in Medicare Annual Wellness Visit Utilization

Abstract

Utilization of the AWV has increased modestly since its introduction, but remains low. Utilization varies by ethnoracial group, with disparities largely explained by differences in income and education. Further efforts are needed to evaluate AWV utilization and effectiveness, especially among low socioeconomic status ethnoracial minorities.

Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US

“…Our study only had 6.3% Hispanics, whereas Hispanics represented 10.7% of the population in the previous study. 20 Hispanic particpants in the present study may be a more selected group and, thus, possibly healthier than the general Hispanic population in the US, because they represent a smaller proportion of the final study population compared to other studies. This may be explained by the strict selection criteria ( Figure A1), which may have influenced the inclusion of this race/ethnic group more than non-Hispanic white and black participants.…”

“…This is indirectly supported in a number of other studies that identified residence in more affluent areas and non-rural metropolitan areas to have higher AWV utilization. 11,18,20,21 Hispanic ethnicity and female sex were significantly associated with greater AWV utilization in the multivariable logistic regression analysis. Previous studies of sex are inconsistent.…”

“…11,21 Studies have shown lower AWV utilization among non-Hispanic Black and other race/ethnicity groups compared to non-Hispanic White Medicare beneficiaries. 11,18,20,21 One study that investigated utilization among Hispanic beneficiaries found lower utilization of AWVs in comparison to non-Hispanic White beneficiaries in univariable analysis, but no association in multivariable analysis. 20 The surprising finding from our analysis that AWV utilization was higher in Hispanic beneficiaries compared to non-Hispanic White and Black beneficiaries may not be representative of the full Medicare population.…”

“…11,18,20,21 One study that investigated utilization among Hispanic beneficiaries found lower utilization of AWVs in comparison to non-Hispanic White beneficiaries in univariable analysis, but no association in multivariable analysis. 20 The surprising finding from our analysis that AWV utilization was higher in Hispanic beneficiaries compared to non-Hispanic White and Black beneficiaries may not be representative of the full Medicare population. Our study only had 6.3% Hispanics, whereas Hispanics represented 10.7% of the population in the previous study.…”

“…[10][11][12][13][14][15][16][17] At the same time, primary care physician practices and geographical regions where AWVs are more frequently adopted do not deliver a higher amount of healthcare services overall. 18 Despite a gradual increase in utilization of AWVs after their introduction in 2011, [17][18][19][20][21] less than a quarter of Medicare beneficiaries received an AWV in 2015. 19 Previous studies have identified underutilization of AWVs among older adults who are unmarried, members of a race/ethnic minority group, or living in rural or less affluent areas.…”