Disparities in Antidepressant Treatment in Medicaid Elderly Diagnosed with Depression

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Abstract
Objectives: To determine whether there were racial or ethnic disparities in the use of antidepressants in low‐income elderly patients insured by Medicaid.Design: Examination of 1998 Medicaid claims data.Setting: Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states.Participants: All Medicaid recipients aged 65 to 84 with a diagnosis of depression.Measurements: Treatment versus no treatment; in those treated, treatment with drugs was classified as old‐ or new‐generation antidepressants.Results: In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African‐American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long‐term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62–2.24). Patients in long‐term care facilities and those aged 65 to 74 were less likely to receive treatment.Conclusion: Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African‐American patients.