Applications of Trajectory and Transition Modeling Methods to Characterize the Dynamic Relationship Between Food Insecurity, Health, and Health Care Use in Low-Income Older Adults in the United States

项目总结 粮食不安全是一种未得到满足的社会需求，与较差的健康和较高的死亡率、发病率、健康率有关。 护理使用和卫生保健支出。在美国的老年人中，食物不安全尤其令人担忧 由于最近患病率的上升及其与营养等健康老龄化障碍的关联 缺乏、多种慢性病、功能受限、跌倒和认知能力下降。越来越多的人 食物不安全的老年人对医疗保健提供系统提出了额外的要求，以提供 协调的全人护理，有效和高效地回应老年人的医疗需求 成年人和他们的社会背景。要实现这一点，提供商需要严格的、纵向的证据来解决 粮食不安全对老年人保健需求、保健和保健的短期和长期影响 食品不安全随时间波动的后果，以及医疗保健使用和患者的影响 未来粮食不安全风险的特点。尽管关于粮食不安全和健康的研究正在增加，但 绝大多数研究使用横断面设计或较短的随访期，没有捕捉到瞬时 粮食不安全的性质，以及它与保健和保健之间的周期性和相辅相成的关系 使用。此外，几乎没有证据表明粮食不安全的纵向模式以及进出的情况。 老年人的粮食不安全，尽管粮食不安全在几个种族和民族中更为普遍 在少数群体中，人们对粮食不安全对卫生保健结果的影响的差异知之甚少 在这些群体中。因此，提供者和卫生系统对何时、如何和为 粮食不安全导致卫生和保健需求的变化。为了解决这些知识差距， 拟议的研究将利用健康和退休研究的五个浪潮，这是一个全国性的代表性研究 对50岁及以上社区居住的老年人进行纵向调查，以表征食物的变化 随着个人年龄的增长，不安全感和医疗保健需求相互影响，并研究这些关系是如何 不同种族和民族之间的差异。为了实现这些目标，该项目旨在(1)比较关联 在白人、非西班牙裔黑人、 和西班牙裔老年人(2)确定低收入老年人的亚群，他们遵循不同的食物不安全 轨迹以及与每个轨迹相关的健康和保健结果；以及(3)估计 不同性别的低收入成年人食物不安全的概率 种族/族裔特性、人口和社会经济特征、保健需求和保健 经历。这项研究将使用新的应用轨迹和过渡建模方法来改进 关于粮食不安全和卫生保健使用之间的纵向关系的基础知识，以便 告知卫生保健提供系统能力的改进，以识别、预测和干预 食物缺乏保障的老年人的医疗保健需求。

PROJECT SUMMARY Food insecurity is an unmet social need associated with poorer health and higher mortality, morbidity, health care use, and health care expenditures. Among older adults in the U.S., food insecurity is of particular concern due to its recent rise in prevalence and its association with barriers to healthy aging such as nutrient deficiencies, multiple chronic conditions, functional limitations, falls, and cognitive decline. The growing number of food-insecure older adults places additional demands on health care delivery systems to provide coordinated and whole-person care that effectively and efficiently responds to the medical needs of older adults and their social context. To achieve this, providers need rigorous, longitudinal evidence addressing the short- and long-term impacts of food insecurity on older adults’ health care needs, the health and health care consequences of fluctuations in food insecurity over time, and the influence of health care use and patient characteristics on future food insecurity risk. Although research on food insecurity and health is growing, the vast majority of studies use cross-sectional designs or short follow-up periods and do not capture the transient nature of food insecurity, nor the cyclical and mutually reinforcing relationship it has with health and health care use. Moreover, there is scant evidence on longitudinal patterns of food insecurity and transitions into and out of food insecurity in older adults, and although food insecurity is more prevalent among several racial and ethnic minority groups, little is known about differences in the influence of food insecurity on health care outcomes across these groups. As a result, providers and health systems have limited knowledge of when, how, and for whom food insecurity results in changes in health and health care needs. To address these knowledge gaps, the proposed study will leverage five waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling older adults ages 50 and over, to characterize how changes in food insecurity and health care needs influence each other as individuals age and examine how these relationships vary across racial and ethnic groups. To achieve these goals, the project aims to (1) compare associations between food insecurity and changes in health and health care outcomes among white, non-Hispanic Black, and Hispanic older adults (2) identify sub-groups of low-income older adults who follow different food insecurity trajectories and the health and health care outcomes associated with each trajectory; and (3) estimate the probabilities of becoming, staying, or ceasing to be food insecure among low-income adults with different racial/ethnic identities, demographic and socioeconomic characteristics, health needs, and health care experiences. This study will employ novel applications of trajectory and transition modeling methods to improve foundational knowledge on the longitudinal relationship between food insecurity and health care use in order to inform improvements in the capacity of health care delivery systems to identify, anticipate, and intervene on the health care needs of food-insecure older adults.