Abstract
Wedescribe a method for the development of cohorts of up to three quarters of the 14 million married couples aged 65 and over in the United States. The health care experiences, illness histories, and mortality of these identified couples can be assessed longitudinally using Medicare data. We summarize strengths and limitations of using data from Medicare administrative records for the study of marriage, health, and aging. We illustrate the method by demonstrating substantial differences in survival in a cohort of hospice patients as a function of not only the patient's own diagnosis and illness burden but also the patient's spouse's illness burden.
The text of this article is only available as a PDF.
References
Asch, D.A., Jedrziewski, M.K., & Christakis, N.A. (
1998
). Response Rates to Mail Surveys Published in Medical Journals
. Journal of Clinical Epidemiology
, 50
, 1129
–36
. 10.1016/S0895-4356(97)00126-1Carter, G.M., Newhouse, J.P., & Relies, D.A. (
1990
). How Much Change in the Case Mix Index Is DRG Creep?
. Journal Health Economics
, 9
, 411
–28
. 10.1016/0167-6296(90)90003-LCharlson, M.E., Pompei, P., Ales, K.L, & MacKenzie, C.R. (
1987
). A New Method of Classifying Prognostic Co-morbidity in Longitudinal Studies: Development and Validation
. Journal of Chronic Disease
, 40
, 373
–83
. 10.1016/0021-9681(87)90171-8Christakis, N.A. (
1998
). Predicting Patient Survival Before and After Hospice EnroIlment
. The Hospice Journal
, 13
(1–2
), 71
–78
.Christakis, N.A., & Escarce, J.J. (
1996
). Survival of Medicare Patients After EnroIlment in Hospice Programs
. New England Journal of Medicine
, 335
, 172
–78
. 10.1056/NEJM199607183350306Christakis, N.A., & Iwashyna, T.J. (
1998
). Spousal Illness Burden is Associated With Delayed Use of Hospice Care in Terminally III Patients
. Journal of Palliative Medicine
, 1
(1
), 3
–10
. 10.1089/jpm.1998.1.3Cutler, D.M. (
1995
). The Incidence of Adverse Medical Outcomes Under Prospective Payment
. Econometrica
, 62
, 29
–50
. 10.2307/2951696Dawson, N.J. (
1991
). Need Satisfaction in Terminal Care Settings
. Social Science and Medicine
, 32
, 83
–87
. 10.1016/0277-9536(91)90131-UDeyo, R.A., Cherkin, D.C., & Ciol, M.A. (
1992
). Adapting a Clinical Comorbidity Index for Use With ICD-9-CM Administrative Databases
. Journal of Clinical Epidemiology
, 45
, 613
–19
. 10.1016/0895-4356(92)90133-8Fisher, E.S., Barton, J.A., Malenka, D.J., Barrett, J., & Bubolz, T.A. (
1990
). Overcoming Potential Pitfalls in the Medicare Data for Epidemiologic Research
. American Journal of Public Health
, 80
, 533
–46
. 10.2105/AJPH.80.12.1487Goldberg, J., Miles, T.P., Furner, S., Meyer, J.M., Hinds, A., Ramakrishnan, V., Lauderdale, D.S., & Levy, P.S. (
1997
). Identification of a Cohort of Male and Female Twins Aged 65 Years or More in the United States
. American Journal of Epidemiology
, 145
, 175
–83
.Public Use Files
. (1997
). Baltimore
: Health Care Financing Administration
.Kidder, D. (
1992
). The Effects of Hospice Coverage on Medicare Expenditures
. Health Services Research
, 27
, 195
–217
.Lauderdale, D.S., Furner, S.E., Miles, T.P., & Goldberg, J. (
1993
). Epidemiologic Uses of Medicare Data
. Epidemiologic Reviews
, 15
, 319
–27
.Lauderdale, D.S., & Goldberg, J. (
1996
). The Expanded Racial and Ethnic Codes in the Medicare Data Files: Their Completeness and Accuracy
. American Journal of Public Health
, 86
, 712
–16
. 10.2105/AJPH.86.5.712Lillard, L.A., & Waite, L.J. (
1995
). Til Death Do Us Part': Marital Disruption and Mortality
. American Journal of Sociology
, 100
, 1131
–56
. 10.1086/230634McBean, A.M., Warren, J.L., & Babish, J.D. (
1994
). Measuring the Incidence of Cancer in Elderly Americans Using Medicare Claims Data
. Cancer
, 73
, 2417
–25
. 10.1002/1097-0142(19940501)73:9<2417::AID-CNCR2820730927>3.0.CO;2-LMitcheIl, J.B., Bubolz, T., Paul, J.E., Pashos, C.L., Escarce, J.J., Muhlbaier, L.H., Wiesman, J.M., Young, W.W., Epstein, R.S., & Javitt, J.C. (
1994
). Using Medicare Claims for Outcomes Research
. Medical Care
, 32
, JS38
–51
. 10.1097/00005650-199407001-00003Mor, V., Greer, D.S., & Kastenbaum, R. (
1988
). The Hospice Experiment
. Baltimore
: The Johns Hopkins Press
.Morgan, R.O., Viring, B.A., DeVito, C.A., & Persily, N.A. (
1997
). The Medicare-HMO Revolving Door-The Healthy Go In and the Sick Go Out
. New England Journal of Medicine
, 337
, 169
–75
. 10.1056/NEJM199707173370306Parkes, C.M. (
1972
). Accuracy of Predictions of Survival in Later Stages of Cancer
. British Journal of Medicine
, 2
, 29
–31
. 10.1136/bmj.2.5804.29Riley, G.F., Feuer, E.J., & Lubitz, J.D. (
1996
). Disenrollment of Medicare Cancer Patients From Health Maintenance Organizations
. Medical Care
, 34
, 826
–36
. 10.1097/00005650-199608000-00009Schoen, R.S., & Nelson, V.E. (
1974
). Marriage, Divorce and Mortality: A Life Table Analysis
. Demography
, 11
, 267
–90
. 10.2307/2060563Social Security Bulletin. 1996. Fall 59(3). Washington, DC: U.S. Government Printing Office.
The SUPPORT Principal Investigators
(1995
). A Controlled Trial to Improve Care for Seriously III Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT)
. Journal of the American Medical Association
, 274
, 1591
–98
. 10.1001/jama.274.20.1591Marital Status and Living Arrangements. March 1995 (Update)
. (1996
). Washington, DC
: Electronic Release
.Vital Statistics of the United States. 1991. Volume IIA: Mortality
. (1991
). Washington, DC
: U.S. Government Printing Office
.1996 Green Book: Overview of Entitlement Programs
. (1996
). Washington, DC
: U.S. Government Printing Office
.© Population Association of America 1998
1998
Issue Section:
Old-Age Mortality and Morbidity
