Alcohol diagnoses among older Tennessee Medicare beneficiaries: race and gender differences.

Background: These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups.

Methods: We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered.

Results: Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups.

Conclusions: Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.