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Analysis

Older Adults With Low Incomes are Healthier in Affluent Communities

By Christopher Cheney  
   September 17, 2019

New research indicates that healthier areas of the country are healthier across all dimensions.

In a finding that expands on social determinants of health research, a new study shows that older adults with low incomes are healthier if they live in affluent communities.

Social determinants of health (SDOH) such as housing, food security, and transportation can have a pivotal impact on the physical and mental health of patients. By making direct investments in initiatives designed to address SDOHs and working with community partners, healthcare organizations can help their patients in profound ways beyond the traditional provision of medical services.

The new study, which was published in Annals of Internal Medicine, examined data from nearly 6.4 million Medicare beneficiaries who had participated in the Medicare Part D prescription drug program. The researchers focused on more than 700 U.S. "commuting zones," which are groupings of counties developed by the federal Department of Agriculture that show economic and social activity as opposed to political boundaries.

The study's data features the prevalence of 48 chronic conditions in commuting zones. The research's key finding is that the prevalence of chronic conditions for older adults with low incomes is significantly lower in affluent commuting zones. "Low-income, older adults living in more affluent areas of the country are healthier, and areas with poor health in the low-income, older adult population tend to have a high prevalence of most chronic conditions," the researchers wrote.

The overall prevalence of the 48 chronic conditions ranged from 72.2 per 100 adults for hypertension to 0.6 per 100 for post-traumatic stress disorder. In addition to hypertension, the five most prevalent chronic conditions were hyperlipidemia, anemia, rheumatoid arthritis and osteoarthritis, ischemic heart disease, and diabetes.

Interpreting the findings
 

Social and other community-related factors are likely responsible for the study's findings rather than access to healthcare services, the report's lead author told HealthLeaders.

"Differences in the social fabric, peer effects, health literacy, community resources, and lifestyle more generally could contribute to this pattern. Many conditions that we examined are chronic, lifelong diseases related to daily health investments throughout someone's life, so it is very unlikely that differences can be attributed to differential availability or access to formal care. Interestingly, we actually find that health is better in rural areas of the country that have traditionally faced challenges in ensuring easy access to formal healthcare," said Maria Polyakova, PhD, assistant professor of health research and policy, Stanford University School of Medicine, Stanford, California.

The primary finding of the study is that healthier areas of the country are healthier on all dimensions, she said.

"There is no one condition that drives geographic health disparities. This points to the idea that policymaking that aims to address health disparities needs to address systemic, root-cause problems of why some areas are less healthy than others. This means spending resources on particular areas and addressing all types of health conditions in those areas, rather than focusing on one condition across many different areas," Polyakova said.

The study is a step forward in understanding the impact of SDOHs on older adults with low incomes, she said. "We use clinical rather than self-reported measures of diagnoses and report this group's variation in morbidity across local areas of the country, rather than nationally. Our results raise the bar for quantifying the importance of social determinants of health and figuring out what factors drive health disparities."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

For older adults with low incomes, new research shows the prevalence of 48 chronic conditions is significantly lower in affluent communities.

Social and other community-related factors are likely responsible for the study's findings rather than access to healthcare services.

The most prevalent chronic conditions in the study were hypertension, hyperlipidemia, anemia, rheumatoid arthritis and osteoarthritis, ischemic heart disease, and diabetes.

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