Does urgent need for medical care go undetected among seniors with lower SES?

In data from 340,910 seniors responding to the nationally representative 2010 Medicare CAHPS Survey, 30% reported having “an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office” in the previous 6 months. As expected, this need varied strongly with health status (e.g. 59% of those in poor self-rated health versus 18% of those in excellent self-rated health). We used a two-stage regression model to calculate the health-based probability of urgent care need for each individual and then examined variations in perceived need by educational attainment. While seniors with lower educational attainment reported somewhat higher levels of urgent care need in unadjusted analyses (e.g. 36% of those who did not attend high school versus 30% of those with postgraduate degrees), this difference was smaller than would be expected given the striking health differences by educational attainment. In multivariate models controlling for multiple health measures, age, and gender, seniors who did not complete high school had 63-77% the odds of reporting the need for urgent care of otherwise similar seniors with postgraduate education (p<0.0001), with larger effects for those in poor health (p<0.05 for interactions). Thus differences in perceived need for urgent care may be one factor underlying socioeconomic gradients in health and mortality. Efforts should be made to assist seniors with lower health literacy in their awareness of important symptoms, improve the clarity of provider communication with seniors, and assist seniors with lower health literacy in interactions with the health care system.