Fabius Chanee D, Thomas Kali S, Cornman Jennifer C, Freedman Vicki A
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
J Am Med Dir Assoc. 2025 Jul 22;26(9):105758. doi: 10.1016/j.jamda.2025.105758.
Little is known about the impacts of living in a long-term services and supports (LTSS) "desert," where there are few community-based care options. We sought to understand whether racial disparities exist in LTSS availability and variety and associations with unmet care needs for non-Hispanic White and Black older adults.
Cross-sectional study of national survey data linked to contextual LTSS market measures.
Non-Hispanic White (n = 1751) and Black (n = 603) adults aged 70 and older with activity limitations from the 2019 National Health and Aging Trends Study (NHATS).
The outcome of interest is any adverse consequence as the result of unmet care needs for household, self-care, or mobility activities. We estimate multivariable logistic regression models adjusting for a novel measure reflecting LTSS availability and variety (fertile, typical, desert), consisting of the number of home health agencies, residential care/assisted living beds, and adult day care providers in a county per 100,000 older adults.
Relative to White older adults, Black older adults more often experienced adverse consequences due to unmet need (35.0% vs 27.6%, P < .03). Although not statistically significant, older Black adults were more likely to live in an LTSS desert (P < .058). In fully adjusted within-group multivariable logistic regression models, living in an LTSS desert was associated with greater odds of experiencing adverse consequences due to unmet need among White, but not Black, older adults (adjusted odds ratio, 1.50; 95% CI, 0.95-2.36). For both White and Black older adults, single older adults and those receiving unpaid or paid community-based care were more likely to experience adverse consequences due to unmet need.
Findings underscore differences in how LTSS availability and variety relate to unmet care needs for Black and White older adults. Future research should examine these associations in other racial and ethnic minoritized groups.
对于生活在长期服务与支持（LTSS）“荒漠”地区（即社区护理选择极少的地区）的影响，我们知之甚少。我们试图了解在LTSS的可及性和多样性方面以及与非西班牙裔白人和黑人老年人未满足的护理需求之间的关联中，是否存在种族差异。
对与背景LTSS市场指标相关的全国调查数据进行横断面研究。
来自2019年国家健康与老龄化趋势研究（NHATS）的1751名非西班牙裔白人及603名黑人成年人，年龄在70岁及以上，存在活动受限情况。
感兴趣的结果是因家庭、自我护理或活动能力方面未满足的护理需求而产生的任何不良后果。我们估计多变量逻辑回归模型，对一种反映LTSS可及性和多样性（丰富、典型、荒漠）的新指标进行调整，该指标由每10万名老年人中一个县的家庭健康机构数量、住宅护理/辅助生活床位数量以及成人日托服务提供者数量组成。
与白人老年人相比，黑人老年人因未满足需求而更常经历不良后果（35.0%对27.6%，P <.03）。虽然无统计学意义，但黑人老年人更有可能生活在LTSS荒漠地区（P <.058）。在完全调整的组内多变量逻辑回归模型中，生活在LTSS荒漠地区与白人老年人（而非黑人老年人）因未满足需求而经历不良后果的更高几率相关（调整后的优势比为1.50；95%置信区间为0.95 - 2.36）。对于白人和黑人老年人而言，单身老年人以及接受无偿或有偿社区护理的老年人因未满足需求而更有可能经历不良后果。
研究结果凸显了LTSS的可及性和多样性与白人和黑人老年人未满足的护理需求之间关系的差异。未来研究应在其他种族和少数族裔群体中考察这些关联。
