Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
J Am Geriatr Soc. 2018 Jul;66(6):1158-1164. doi: 10.1111/jgs.15366. Epub 2018 Apr 12.
To examine whether neighborhood context moderates the relationship between multiple chronic conditions (MCCs) and function in Medicare Advantage (MA) beneficiaries.
Cross-sectional study.
Medicare Health Outcome Survey Cohort 16 baseline data from 2013.
MA beneficiaries aged 65 and older (N=187,434).
We defined disadvantaged neighborhoods as those with an Area Deprivation Index greater than the 85 percentile. MCCs was defined as having 2 or more chronic conditions. The primary outcome was any self-reported functional limitations with a basic or instrumental activity of daily living. We used survey-weighted multivariate linear probability regression to examine whether the neighborhood disadvantage moderates the relationship between MCCs and report of a functional limitation.
More than one third (35.6%) of the sample reported a functional limitation. Beneficiaries with MCCs were more likely to report a functional limitation those with 0 or 1 chronic condition (odds ratio (OR)=2.63, 95% confidence interval (CI)=2.50-2.77). Beneficiaries in more-disadvantaged neighborhoods were more likely to report a functional limitation than those in less-disadvantaged neighborhoods (OR=1.14, 95% CI=1.08-1.21). In older adults with MCCs, the probability of reporting a functional limitation was 12 percentage points greater in those living in more-disadvantaged neighborhoods than in those living in less-disadvantaged neighborhoods.
Neighborhood context is a significant predictor of functional limitation and moderates the association between chronic conditions and functional limitations. Health plans and public health officials could use publicly available indicators such as the ADI to target interventions to reduce functional impairment.
探讨多种慢性疾病（MCCs）与医疗保险优势计划（MA）受益人群功能之间的关系是否受邻里环境的调节。
横断面研究。
来自 2013 年医疗保险健康结果调查队列 16 基线数据。
65 岁及以上的 MA 受益人群（N=187434）。
我们将弱势邻里定义为区域剥夺指数大于第 85 百分位数的邻里。MCCs 定义为患有 2 种或以上慢性疾病。主要结局是任何自我报告的功能限制，包括基本或工具性日常生活活动受限。我们使用调查加权多元线性概率回归来检验邻里劣势是否调节 MCCs 与功能受限报告之间的关系。
超过三分之一（35.6%）的样本报告存在功能受限。患有 MCCs 的受益人群比患有 0 或 1 种慢性疾病的受益人群更有可能报告功能受限（比值比（OR）=2.63，95%置信区间（CI）=2.50-2.77）。处于更弱势邻里的受益人群比处于弱势邻里的受益人群更有可能报告功能受限（OR=1.14，95% CI=1.08-1.21）。在患有 MCCs 的老年人中，生活在更弱势邻里的受益人群报告功能受限的概率比生活在弱势邻里的受益人群高 12 个百分点。
邻里环境是功能受限的重要预测指标，并调节了慢性疾病与功能受限之间的关系。健康计划和公共卫生官员可以使用公开可用的指标，如 ADI，针对干预措施以减少功能障碍。
