ArticleJournal of the American Geriatrics Society2025
Racial and Ethnic Differences in Low-Value Care Among Older Adults in a Large Statewide Health System.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundAs value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Therefore, we measured racial differences in LVC in a contemporary sample.
methodsWe conducted a cross-sectional analysis of claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. Our sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing). We examined associations between race/ethnicity with outcomes using multivariable regression models adjusted for patient characteristics and medical center.
resultsAmong 15,720 members who received potentially LVC, non-Hispanic White older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), other race (2%). In adjusted models, Asian (-4.9 percentage points [pp]; 95% CI -5.9, -3.8 pp), Black (-5.4 pp; 95% CI -8.0, -2.7 pp), and Latino (-2.5 pp; 95% CI -4.6, -0.4 pp) older adults were less likely to receive LVC compared to White older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.
conclusionsThese diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.
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