Stanford University School of Medicine, Stanford, California, and the National Bureau of Economic Research, Cambridge, Massachusetts (M.P.).
University of Pennsylvania, Philadelphia, Pennsylvania (L.M.H.).
Ann Intern Med. 2019 Oct 1;171(7):464-473. doi: 10.7326/M18-2800. Epub 2019 Sep 10.
Recent studies have reported that low-income adults living in more affluent areas of the United States have longer life expectancies. Less is known about the relationship between the affluence of a geographic area and morbidity of the low-income population.
To evaluate the association between the prevalence of chronic conditions among low-income, older adults and the economic affluence of a local area.
Cross-sectional association study.
Medicare in 2015.
6 363 097 Medicare beneficiaries aged 66 to 100 years with a history of low-income support under Medicare Part D.
Adjusted prevalence of 48 chronic conditions was computed for 736 commuting zones (CZs). 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 average of condition prevalence index across deciles of median CZ house values.
The mean age of study participants was 77.7 years (SD, 8.2); 67% were women, and 61% were white. The crude prevalence of 48 chronic conditions ranged from 72.5 per 100 for hypertension to 0.6 per 100 for posttraumatic stress disorder. The prevalence of these 48 chronic conditions was highly spatially correlated. Composite condition prevalence was on average substantially lower in more affluent CZs.
Low-income status measured on the basis of receipt of Medicare Part D low-income subsidies and not capturing persons not enrolled in Medicare Part D.
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.
National Institute on Aging.
最近的研究报告称，生活在美国较富裕地区的低收入成年人的预期寿命更长。关于地理区域的富裕程度与低收入人群的发病情况之间的关系，人们了解得较少。
评估低收入老年人群中慢性疾病的流行情况与当地经济富裕程度之间的关系。
横断面关联性研究。
2015 年的医疗保险。
6363097 名医疗保险受益人，年龄在 66 岁至 100 岁之间，曾在医疗保险 D 部分下享受低收入支持。
计算了 736 个通勤区（CZ）中 48 种慢性疾病的调整后流行率。使用因子分析评估疾病流行率的空间变异，并为每个 CZ 构建一个综合疾病流行率指数。通过比较中位数 CZ 房屋价值十等份的疾病流行率指数平均值来衡量发病情况与地区富裕程度之间的关系。
研究参与者的平均年龄为 77.7 岁（标准差，8.2 岁）；67%为女性，61%为白人。48 种慢性疾病的总流行率从高血压的每 100 人 72.5 例到创伤后应激障碍的每 100 人 0.6 例不等。这些 48 种慢性疾病的流行率具有高度的空间相关性。在更富裕的 CZ 中，综合疾病流行率平均要低得多。
根据接受医疗保险 D 部分低收入补贴来衡量低收入状况，并未涵盖未参加医疗保险 D 部分的人群。
生活在该国较富裕地区的低收入、老年人群体更健康，而在低收入老年人群体中健康状况较差的地区往往存在大多数慢性疾病的高流行率。
美国国家老龄化研究所。
