收入与老年医疗保险受益人中居家状态变化的关联性。
The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.
机构信息
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2020 Nov;68(11):2594-2601. doi: 10.1111/jgs.16715. Epub 2020 Aug 10.
IMPORTANCE
A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status.
OBJECTIVE
To evaluate the association between income and risk of becoming homebound.
DESIGN
Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older.
SETTING
Population-based study in the United States.
PARTICIPANTS
A total of 7,042 initially nonhomebound community-dwelling older adults.
EXPOSURE
Total annual household income at baseline (in 2011) measured via self-report.
OUTCOME
Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less.
RESULTS
Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20-2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile.
CONCLUSION AND RELEVANCE
Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.
重要性
患有多种疾病、认知障碍和功能残疾的老年人口数量庞大且不断增加，他们居住在社区中，但许多人从未或很少离开过家。居家不出与获得医疗服务的机会减少、健康状况不佳和死亡率增加有关。然而，目前尚不清楚哪些因素（特别是社会经济因素）与居家不出状态的新发病例有关。
目的
评估收入与成为居家不出者的风险之间的关系。
设计
利用 2011 年至 2018 年来自全国健康老龄化趋势研究（一项针对 65 岁及以上医疗保险受益人的全国代表性样本）的数据，进行 2011 年至 2018 年的数据进行观察性队列研究。
地点
美国的一项基于人群的研究。
参与者
共有 7042 名最初非居家不出的社区居住的老年成年人。
暴露
通过自我报告，在基线（2011 年）测量的家庭年收入的总年度数。
结果
在 7 年期间，收入最低四分位数（≤$15,003）的老年人中有 15.81%成为居家不出者，而收入最高四分位数（>$60,000）的老年人中只有 4.64%成为居家不出者。在一项竞争风险分析中，考虑到死亡和疗养院入院的风险，并调整了临床和人口统计学特征，收入最低四分位数的人成为居家不出者的亚危险度大大高于收入最高四分位数的人（1.65；95%置信区间=1.20-2.29）。此外，我们发现收入四分位数与居家不出状态风险之间存在梯度。
结论和相关性
我们的研究表明，财务资源塑造了成为居家不出者的风险，而这与健康后果不佳有关。在现有收入差距的背景下，需要更多的支持来帮助那些经济资源有限但希望留在社区中的老年人。
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