Maria Polyakova, PhD; Lynn M. Hua, BA
Acknowledgment: The authors thank the National Institute on Aging for their generous support.
Grant Support: National Institute on Aging grants R21AG052833, P01AG005842-29, and K01AG05984301.
Disclosures: Dr. Polyakova reports grants from the National Institute on Aging during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2800.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Not applicable. Statistical code: Available from Dr. Polyakova (e-mail, firstname.lastname@example.org) and at http://web.stanford.edu/~mpolyak. Data set: Original data set not available due to data use agreement restrictions. Interested researchers can submit an application for a data use agreement at www.resdac.org. Data with CZ-level LACCI and adjusted chronic condition prevalences are available at http://web.stanford.edu/~mpolyak and in the Supplement.
Corresponding Author: Maria Polyakova, PhD, Stanford University School of Medicine, Redwood Building, Room T111, 150 Governor's Lane, Stanford, CA 94305; e-mail, email@example.com.
Current Author Addresses: Dr. Polyakova: Stanford University School of Medicine, Redwood Building, Room T111, 150 Governor's Lane, Stanford, CA 94305.
Ms. Hua: The Wharton School, University of Pennsylvania, 204 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104-6218.
Author Contributions: Conception and design: M. Polyakova.
Analysis and interpretation of the data: M. Polyakova, L.M. Hua.
Drafting of the article: M. Polyakova, L.M. Hua.
Critical revision of the article for important intellectual content: M. Polyakova.
Final approval of the article: M. Polyakova.
Provision of study materials or patients: M. Polyakova.
Statistical expertise: M. Polyakova, L.M. Hua.
Obtaining of funding: M. Polyakova.
Administrative, technical, or logistic support: M. Polyakova, L.M. Hua.
Collection and assembly of data: M. Polyakova.
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.
Polyakova M, Hua LM. Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States: A Cross-sectional Study. Ann Intern Med. [Epub ahead of print 10 September 2019]:. doi: 10.7326/M18-2800
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Published: Ann Intern Med. 2019.
Geriatric Medicine, Healthcare Delivery and Policy.
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