Abstract：
BACKGROUND: Low neighborhood socioeconomic status is associated with adverse health outcomes, but its association with health care costs in older adults is uncertain.
OBJECTIVE: To estimate the association of neighborhood Area Deprivation Index (ADI) with total, inpatient, outpatient, skilled nursing facility (SNF), and home health care (HHC) costs among older community-dwelling Medicare beneficiaries, and determine whether these associations are explained by multimorbidity, phenotypic frailty, or functional impairments.
METHODS: Four prospective cohort studies linked with each other and with Medicare claims.
METHODS: In total, 8165 community-dwelling fee-for-service beneficiaries (mean age 79.2 years, 52.9% female).
METHODS: ADI of participant residence census tract, Hierarchical Conditions Category multimorbidity score, self-reported functional impairments (difficulty performing four activities of daily living), and frailty phenotype. Total, inpatient, outpatient, post-acute SNF, and HHC costs (US 2020 dollars) for 36 months after the index examination.
RESULTS: Mean incremental annualized total health care costs adjusted for age, race/ethnicity, and sex increased with ADI ($3317 [95% CI 1274 to 5360] for the most deprived vs least deprived ADI quintile, and overall p-value for ADI variable 0.009). The incremental cost for the most deprived vs least deprived ADI quintile was increasingly attenuated after separate adjustment for multimorbidity ($2407 [95% CI 416 to 4398], overall ADI p-value 0.066), frailty phenotype ($1962 [95% CI 11 to 3913], overall ADI p-value 0.22), or functional impairments ($1246 [95% CI -706 to 3198], overall ADI p-value 0.29).
CONCLUSIONS: Total health care costs are higher for older community-dwelling Medicare beneficiaries residing in the most socioeconomically deprived areas compared to the least deprived areas. This association was not significant after accounting for the higher prevalence of phenotypic frailty and functional impairments among residents of socioeconomically deprived neighborhoods.
OBJECTIVE: To estimate the association of neighborhood Area Deprivation Index (ADI) with total, inpatient, outpatient, skilled nursing facility (SNF), and home health care (HHC) costs among older community-dwelling Medicare beneficiaries, and determine whether these associations are explained by multimorbidity, phenotypic frailty, or functional impairments.
METHODS: Four prospective cohort studies linked with each other and with Medicare claims.
METHODS: In total, 8165 community-dwelling fee-for-service beneficiaries (mean age 79.2 years, 52.9% female).
METHODS: ADI of participant residence census tract, Hierarchical Conditions Category multimorbidity score, self-reported functional impairments (difficulty performing four activities of daily living), and frailty phenotype. Total, inpatient, outpatient, post-acute SNF, and HHC costs (US 2020 dollars) for 36 months after the index examination.
RESULTS: Mean incremental annualized total health care costs adjusted for age, race/ethnicity, and sex increased with ADI ($3317 [95% CI 1274 to 5360] for the most deprived vs least deprived ADI quintile, and overall p-value for ADI variable 0.009). The incremental cost for the most deprived vs least deprived ADI quintile was increasingly attenuated after separate adjustment for multimorbidity ($2407 [95% CI 416 to 4398], overall ADI p-value 0.066), frailty phenotype ($1962 [95% CI 11 to 3913], overall ADI p-value 0.22), or functional impairments ($1246 [95% CI -706 to 3198], overall ADI p-value 0.29).
CONCLUSIONS: Total health care costs are higher for older community-dwelling Medicare beneficiaries residing in the most socioeconomically deprived areas compared to the least deprived areas. This association was not significant after accounting for the higher prevalence of phenotypic frailty and functional impairments among residents of socioeconomically deprived neighborhoods.
摘要：
背景：社区社会经济地位低与不良健康结果相关，但其与老年人医疗保健费用的关系尚不确定。
目的：估计邻域剥夺指数(ADI)与总数的关联，住院,门诊病人,熟练护理机构（SNF），和老年社区居民医疗保险受益人的家庭保健(HHC)费用，并确定这些关联是否由多发病率解释，表型脆弱，或功能受损。
方法：四项前瞻性队列研究相互关联，并与医疗保险索赔相关。
方法：总共，8165名社区住宿费服务受益人(平均年龄79.2岁，52.9%女性）。
方法：参与者居住地人口普查的ADI，分层条件类别多发病率评分,自我报告的功能障碍（执行四项日常生活活动困难），和脆弱的表型。总计,住院,门诊病人,急性后SNF,指数检查后36个月的HHC成本（2020美元）。
结果：按年龄调整的平均增量年度医疗总费用，种族/民族,ADI增加了性别（最贫困的ADI五分位数为3317美元[95%CI1274至5360]，和ADI变量0.009的总p值)。在对多发病率进行单独调整后，最贫困与最贫困的ADI五分位数的增量成本逐渐减弱($2407[95%CI416至4398]，总ADIp值0.066)，脆弱表型(1962美元[95%CI11至3913]，总ADIp值0.22)，或功能损害(1246美元[95%CI-706至3198]，总ADIp值0.29)。
结论：与最贫困的地区相比，居住在社会经济最贫困的地区的老年社区居民医疗保险受益人的总医疗保健费用更高。在考虑到社会经济贫困社区居民中表型虚弱和功能障碍的患病率较高之后，这种关联并不显着。
目的：估计邻域剥夺指数(ADI)与总数的关联，住院,门诊病人,熟练护理机构（SNF），和老年社区居民医疗保险受益人的家庭保健(HHC)费用，并确定这些关联是否由多发病率解释，表型脆弱，或功能受损。
方法：四项前瞻性队列研究相互关联，并与医疗保险索赔相关。
方法：总共，8165名社区住宿费服务受益人(平均年龄79.2岁，52.9%女性）。
方法：参与者居住地人口普查的ADI，分层条件类别多发病率评分,自我报告的功能障碍（执行四项日常生活活动困难），和脆弱的表型。总计,住院,门诊病人,急性后SNF,指数检查后36个月的HHC成本（2020美元）。
结果：按年龄调整的平均增量年度医疗总费用，种族/民族,ADI增加了性别（最贫困的ADI五分位数为3317美元[95%CI1274至5360]，和ADI变量0.009的总p值)。在对多发病率进行单独调整后，最贫困与最贫困的ADI五分位数的增量成本逐渐减弱($2407[95%CI416至4398]，总ADIp值0.066)，脆弱表型(1962美元[95%CI11至3913]，总ADIp值0.22)，或功能损害(1246美元[95%CI-706至3198]，总ADIp值0.29)。
结论：与最贫困的地区相比，居住在社会经济最贫困的地区的老年社区居民医疗保险受益人的总医疗保健费用更高。在考虑到社会经济贫困社区居民中表型虚弱和功能障碍的患病率较高之后，这种关联并不显着。
