Essay : Age and Gender Adjustment in Two Managed Care Organizations

HCM 530
Case Study 3
Age and Gender Adjustment in Two Managed Care Organizations
The purpose of standardization is to make two or more populations “similar” along dimensions in which
they differ. Earlier, we demonstrated two methods of age-adjustment. For example, we know that
Florida has proportionately more older folks, and older folks die at higher rates than younger folks. In
order to compare the mortality rate of Florida to Alaska, we needed to control for this disparity by
adjusting for differences in the age mix of the two states. Conceptually, we can adjust for more than
one dimension, e.g., age and gender, if we want to compare two or more populations, know that the
age and gender mix will be different in those two populations, and also know that some disease-specific
mortality rates depend on both age and gender. Such is the case with cardiovascular disease in two
large MCOs, Bluegrass East (BGE) and Bluegrass West (BGW), the former with 100,000 members, and
the latter with 120,000 members. Suppose we want to compare the cardiovascular mortality rate of
BGE and BGW. Suppose that BGE has a higher proportion of older folks, and a higher proportion of
women, than BGW. Assume that the crude disease-specific mortality rate for cardiovascular disease is
290 (per 100,000) in BGE and 160 (per 100,000) in BGW.
QUESTIONS

1. From these statistics alone, which MCO has the higher cardiovascular mortality rate?
2. The member mix in BGE and BGW is quite different. In BGW, 90% of the population is less than 55 years old compared to 77% in BGE. Refer to Table 6.7 to guide the calculation of age-adjusted cardiovascular mortality rates using the direct age- adjustment technique and the U.S. population as the standard. With age-adjusted rates, which MCO has the higher mortality rate?
3. Now assume that 60% of the members in BGW are men compared to 40% in BGE. Men have
   higher cardiovascular mortality rates than women. Refer to Table 6.8 to calculate age and gender
   adjusted cardiovascular mortality rates. With age- and gender-adjusted rates, which MCO has the
   higher cardiovascular mortality rate?
   Table 6.7 Direct age adjustment of cardiovascular mortality for Bluegrass East (BGE) and
   Bluegrass West (BGW) Managed Care Organizations
   Age Age-specific
   Mortality
   rate
   Per 100,000
   BGW
   Age-specific
   Mortality
   rate
   Per 100,000
   BGE
   U.S. mix
   (2000)
   BGW
   expected
   BGE
   expected
   1-54 25 20 210,000,000
   55+ 1300 1325 70,000,000
   Total 280,000,000
   Table 6.8. Direct age and gender adjusted cardiovascular mortality for Bluegrass East (BGE)
   and Bluegrass West (BGW) Managed Care Organizations
   Age Ageandgenderspecific
   Mortality
   rate
   Per 100,000
   BGW
   Ageandgenderspecific
   Mortality
   rate
   Per 100,000
   BGE
   US BGW
   (expected)
   BGE
   (expected)
   Males
   1-54
   55+
   30
   1425
   30
   1500
   105,000,000
   35,000,000
   Females
   1-54
   55+
   10
   1175
   15
   1225
   100,000,000
   40,000,000
   280,000,000

SAMPLE SOLUTION

Age and Gender Adjustment

Question 1 Based on the provided statistics, it is evident that Bluegrass East records higher rate of cardiovascular mortality. A number of factors may lead to this state of affairs. First of all, there is a high likelihood that the higher statistics recorded by Bluegrass East are as a result of the patients’ gender and age. Although cardiovascular disease is considered the leading cause of mortality in both male and female gender, there exist significant gender differences in the prevalence of the condition. Generally, the number of females living and dying of cardiovascular disease exceeds those of males (Mieszczanska & Velarde, 2014). On the same note, age is a known risk factor, which is non-modifiable for obvious reasons. With aging, there is a gradual increase in the possibility of acquiring and dying of cardiovascular risk factors in a person’s lifespan. When the various risk factors are integrated into a multivariable…