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

应用轨迹和转移建模方法来描述美国低收入老年人的粮食不安全、健康和医疗保健使用之间的动态关系

• 批准号: 10617008
• 负责人: Kelley Akiya
• 金额: $ 3.57万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10617008
• 关键词: Applications; Trajectory; Transition; Modeling; Methods

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.

项目概要 粮食不安全是一种未满足的社会需求，与健康状况较差和死亡率、发病率、健康状况较高有关 护理使用和医疗保健支出。在美国老年人中，粮食不安全尤其令人担忧 由于其最近的流行率上升及其与健康老龄化障碍（例如营养）的关联 缺陷、多种慢性病、功能限制、跌倒和认知能力下降。数量不断增加 粮食不安全的老年人对医疗保健提供系统提出了额外要求，以提供 协调一致的全人护理，有效且高效地满足老年人的医疗需求 成年人及其社会背景。为了实现这一目标，提供者需要严格的、纵向的证据来解决 粮食不安全对老年人的医疗保健需求、健康和保健的短期和长期影响 粮食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征。尽管有关粮食不安全和健康的研究不断增长， 绝大多数研究使用横断面设计或短期随访，并且没有捕捉瞬态 粮食不安全的性质，及其与健康和保健之间的周期性和相辅相成的关系 使用。此外，关于粮食不安全的纵向模式以及进出经济转型的证据很少。 老年人的粮食不安全问题，尽管粮食不安全问题在一些种族和民族中更为普遍 少数群体对粮食不安全对医疗保健结果影响的差异知之甚少 跨越这些群体。因此，提供者和卫生系统对于何时、如何以及何时了解有限。 粮食不安全导致健康和保健需求的变化。为了解决这些知识差距， 拟议的研究将利用健康与退休研究的五波浪潮，这是一项具有全国代表性的研究 对 50 岁及以上社区居住的老年人进行纵向调查，以描述食物的变化 随着个人年龄的增长，不安全感和医疗保健需求会相互影响，并检查这些关系如何 因种族和族裔群体而异。为了实现这些目标，该项目旨在 (1) 比较关联 白人、非西班牙裔黑人的粮食不安全与健康和医疗保健结果的变化之间， 和西班牙裔老年人 (2) 确定了遵循不同粮食不安全标准的低收入老年人亚组 轨迹以及与每个轨迹相关的健康和保健结果； (3) 估计 不同收入水平的低收入成年人出现、维持或不再处于粮食不安全状态的概率 种族/民族身份、人口和社会经济特征、健康需求和医疗保健 经验。本研究将采用轨迹和转换建模方法的新颖应用来改进 关于粮食不安全和卫生保健利用之间纵向关系的基础知识，以便 为提高医疗保健提供系统的能力提供信息，以识别、预测和干预 粮食不安全的老年人的医疗保健需求。