PAST-DUE (Prevention and Social Determinants: Disparities and Utilization in Latino Elders)

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Project Summary/Abstract Americans aged 60 and over underutilize recommended preventive healthcare. Older Latino-Americans underutilize preventive services to an even greater degree than non-Hispanic whites, but the factors that drive this disparity most heavily are poorly understood. Some evidence in the health services literature suggests that social determinants of health (individual- and community-level economic, social, and environmental factors) affect utilization of preventive health care. It is uncertain, however, which specific services may be most underused by older Latinos, and which social determinants are most strongly associated with this group's utilization. The dearth of knowledge about social determinants and preventive service utilization in older Latinos is due, at least in part, to the lack of comprehensive data on ambulatory health care utilization linked to data on individual- and community-level social determinants of health. This project will assess disparities in preventive service use between older Latinos and older non-Hispanic Whites, and identify the factors underlying those disparities. To do so, we will leverage a unique data resource from a large, national network of community health centers with shared electronic health record data that is linked to community-level social determinants of health data. This large, longitudinal dataset contains unprecedented data linkages which will let us assess disparities, evaluate which social determinants affect utilization and disparities, and determine which of these may do so most significantly over time; in so doing, we will address an important knowledge gap. Understanding the factors (individual or community) that most heavily impact preventive service use is crucial to the prioritization of population-based interventions to improve preventive screening. Understanding the relative impact of social determinants of health on preventive service use in older Latinos will enable action/intervention in three ways: 1. It will enable more informed policy decisions to improve public health and wellness in older Americans. 2. It will facilitate strategic partnerships between healthcare providers and community agencies poised to intervene in social factors in the lives of older Americans. 3. It will help clinical providers understand their patients' barriers to care utilization, and further point-of-care efforts to address these barriers that influence their older patients' utilization of recommended health care services.