Emefah Loccoh is a research associate and Sarnoff Fellow in the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, in Boston, Massachusetts.
Karen E. Joynt Maddox is an assistant professor of medicine at the Washington University School of Medicine and codirector of the Center for Health Economics and Policy at the Institute for Public Health at Washington University in St. Louis, in St. Louis, Missouri.
Health Aff (Millwood). 2021 Feb;40(2):289-296. doi: 10.1377/hlthaff.2020.00420.
There is growing concern about the health of older US adults who live in rural areas, but little is known about how mortality has changed over time for low-income Medicare beneficiaries residing in rural areas compared with their urban counterparts. We evaluated whether all-cause mortality rates changed for rural and urban low-income Medicare beneficiaries dually enrolled in Medicaid, and we studied disparities between these groups. The study cohort included 11,737,006 unique dually enrolled Medicare beneficiaries. Between 2004 and 2017 all-cause mortality declined from 96.6 to 92.7 per 1,000 rural beneficiaries (relative percentage change: -4.0 percent). Among urban beneficiaries, declines in mortality were more pronounced (from 86.9 to 72.8 per 1,000 beneficiaries, a relative percentage change of -16.2 percent). The gap in mortality between rural and urban beneficiaries increased over time. Rural mortality rates were highest in East North Central states and increased modestly in West North Central states during the study period. Public health and policy efforts are urgently needed to improve the health of low-income older adults living in rural areas.
人们越来越关注居住在农村地区的美国老年成年人的健康状况，但对于农村地区的低收入医疗保险受益人（与城市同龄人相比）的死亡率随时间变化的情况知之甚少。我们评估了同时参加医疗补助计划的农村和城市低收入医疗保险受益人的全因死亡率是否发生了变化，并研究了这些群体之间的差异。研究队列包括 11737006 名独特的双重入保医疗保险受益人。在 2004 年至 2017 年间，农村受益人的全因死亡率从每 1000 人 96.6 人降至 92.7 人（相对百分比变化：-4.0%）。在城市受益人中，死亡率的下降更为明显（从每 1000 人 86.9 人降至 72.8 人，相对百分比变化为-16.2%）。农村和城市受益人的死亡率差距随着时间的推移而增加。在研究期间，农村死亡率在东北中部各州最高，中西部北部各州略有上升。迫切需要开展公共卫生和政策工作，以改善居住在农村地区的低收入老年成年人的健康状况。
