Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States

Abstract

Background: Recent work has documented that low-income adults have higher life expectancy in more affluent areas of the US. Less is known about the relationship between area affluence and morbidity in the low-income population.Objective: To evaluate the association between the prevalence of chronic conditions among lowincome older adults and the economic affluence of a local area Design: -Cross-sectional association study. Setting: Medicare in 2015.Participants: 6,363,097 Medicare beneficiaries aged 66 to 100 with a history of low income support under Medicare Part D.Measurements: Adjusted prevalence of 48 chronic conditions was computed for 736 commuting zones (CZ). Factor analysis was used to assess spatial covariation of condition prevalence and to construct a composite condition prevalence index for each CZ. The association between morbidity and area affluence was measured by comparing the mean of condition prevalence index across deciles of median CZ house values.

Relationship of neighborhood and individual socioeconomic status on mortality among older adults: Evidence from cross-level interaction analyses

“…The dynamics of neighborhood and individual-level SES are not well understood. It is thought that higher SES neighborhoods could ameliorate the adverse effect of low individual SES on health by providing a richer physical and social environment [ 27 , 28 ]. On the other hand, low SES individuals residing in high SES neighborhoods could experience higher risks to their health due to exacerbated relative poverty and lack of access to expensive neighborhood resources [ 10 , 11 , 15 ].…”

“…This study used two measures of individual-level SES: annual income and wealth (homeownership). Income is an essential measure of SES that is known to have a large influence on health [ 15 , 27 , 29 ], but income may not solely represent one’s economic conditions, particularly among older adults [ 25 , 30 ]. Income tends to generally decrease later in the life course, which may result in smaller variations in income inequality.…”

Older Adult Health Following Greater Access to Secondary Health Care: Evidence from Bus Service Introductions to Arab Towns in Israel

“…We note thatPolyakova and Hua (2019) also find increased chronic disease rates among low-income older adults in rural areas in the U.S. and speculate that this may be due to systematic under-diagnosis of chronic conditions in less affluent areas.…”

“…This is largely owing to lower insurance coverage, limited knowledge of available medical options, or less access to health care facilities or professionals within geographic proximity. 2 Furthermore, there is growing evidence of a strong correlation between locality of residence and health outcomes, with residents from less advantageous localities experiencing more chronic conditions and premature mortality (Cullen et al (2012); Polyakova and Hua (2019)). Nevertheless, there is limited research on the effects of decreased health care services in disadvantaged communities on health outcomes.…”