New research indicates that healthier areas of the country are
healthier across all dimensions.
KEY TAKEAWAYS
For older
adults with low incomes, new research shows the prevalence of 48 chronic
conditions is significantly lower in affluent communities.
Social
and other community-related factors are likely responsible for the study's
findings rather than access to healthcare services.
The most
prevalent chronic conditions in the study were hypertension, hyperlipidemia,
anemia, rheumatoid arthritis and osteoarthritis, ischemic heart disease, and
diabetes.
In a finding that expands on social determinants of health
research, a new study shows that older adults with low incomes are healthier if
they live in affluent communities.
Social determinants of health (SDOH) such as housing, food
security, and transportation can have a pivotal impact on the physical and mental health of patients. By making
direct investments in initiatives designed to address SDOHs and working with community partners, healthcare
organizations can help their patients in profound ways beyond the traditional
provision of medical services.
The new study, which was published in Annals of Internal
Medicine, examined data from nearly 6.4 million Medicare beneficiaries who
had participated in the Medicare Part D prescription drug program. The
researchers focused on more than 700 U.S. "commuting zones," which
are groupings of counties developed by the federal Department of Agriculture
that show economic and social activity as opposed to political boundaries.
The study's data features the prevalence of 48 chronic conditions
in commuting zones. The research's key finding is that the prevalence of
chronic conditions for older adults with low incomes is significantly lower in
affluent commuting zones. "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," the researchers wrote.
The overall prevalence of the 48 chronic conditions ranged from
72.2 per 100 adults for hypertension to 0.6 per 100 for post-traumatic stress
disorder. In addition to hypertension, the five most prevalent chronic
conditions were hyperlipidemia, anemia, rheumatoid arthritis and
osteoarthritis, ischemic heart disease, and diabetes.
INTERPRETING THE FINDINGS
Social and other community-related factors are likely responsible
for the study's findings rather than access to healthcare services, the
report's lead author told HealthLeaders.
"Differences in the social fabric, peer effects, health
literacy, community resources, and lifestyle more generally could contribute to
this pattern. Many conditions that we examined are chronic, lifelong diseases
related to daily health investments throughout someone's life, so it is very
unlikely that differences can be attributed to differential availability or
access to formal care. Interestingly, we actually find that health is better in
rural areas of the country that have traditionally faced challenges in ensuring
easy access to formal healthcare," said Maria Polyakova, PhD, assistant
professor of health research and policy, Stanford University School of
Medicine, Stanford, California.
The primary finding of the study is that healthier areas of the
country are healthier on all dimensions, she said.
"There is no one condition that drives geographic health
disparities. This points to the idea that policymaking that aims to address
health disparities needs to address systemic, root-cause problems of why some
areas are less healthy than others. This means spending resources on particular
areas and addressing all types of health conditions in those areas, rather than
focusing on one condition across many different areas," Polyakova said.
The study is a step forward in understanding the impact of SDOHs
on older adults with low incomes, she said. "We use clinical rather than
self-reported measures of diagnoses and report this group's variation in
morbidity across local areas of the country, rather than nationally. Our
results raise the bar for quantifying the importance of social
determinants of health and figuring out what factors drive health
disparities."
Christopher
Cheney is the senior clinical care editor at HealthLeaders.
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