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Participants were also asked whether a physician ever told them that they had cancer, diabetes, hypertension, lung disease (chronic bronchitis, emphysema), heart disease (heart attack, coronary artery disease, congestive heart failure, angina, other), or stroke.

AHEAD ethnicity/race information was used to classify people into three mutually exclusive groups: (non-Hispanic) African American, Hispanic, and non-Hispanic White.

People from other racial/ethnic groups are excluded from analyses.

Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Almost all older adults are insured, in contrast to younger age groups for whom of health insurance is an important factor in health services utilization inequities, particularly among ethnic/racial groups (Brown, Ojeda, Wyn, and Levan 2000; Powell-Griner, Bolen, and Bland 1999; Lum and Chang 1998; Stump, Johnson, and Wolinsky 1995; Wolinsky and Johnson 1991).

Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities. Wolinsky, Ph DTHE national consumption of medical services by older adults is an important public policy issue. This approach addressed deficiencies from earlier studies that lacked adequate measures of both health and economic status (Myers, Juster, and Suzman 1997 describes predisposing, need, and enabling factors that predict health care utilization.

Gender and ethnic/racial income inequalities have long been recognized (Danziger and Gottschalk 1993).

Wealth, income, and education inequalities are greatest among older adults, with unmarried women and minorities reporting the lowest resources (Crystal and Shea 1990).The term economic access is used to refer to Andersen 1995).Wealth was evaluated by household net worth, which summarizes the household's tangible wealth in terms of housing equity and nonhousing equity (e.g., savings).These relationships motivate an investigation of gender and ethnic/racial utilization differences, controlling for the burden of chronic diseases and functional limitations in addition to predisposing factors.Third, to what extent does economic access to health care services attenuate gender or ethnic/racial differences in utilization?Functional limitations were evaluated by task limitations in basic activities of daily living (ADLs) and in higher level function related to instrumental ADLs (IADLs) and lower and upper extremity use.