Determinants of Elderly Health: The Role of Place-Based Factors

项目摘要/摘要 老年人健康的决定因素：基于地点的因素的作用 建议的研究目的是为了更好地了解影响健康和健康的因素 美国老年人口的行为超越了先前拨款的工作，这 对老年人医疗保健利用的汇总分析，以直接查看健康行为和健康结果。 正如最近的研究表明的那样，在以下方面，医疗保险人群的预期寿命存在很大差异 种族、收入和地理位置，尽管可以享受相同的全民医疗保险计划。通过检查 两种潜在的基础广泛的力量，即特定于人的因素(“健康资本”)，其中可能包括基因 捐赠以及先前的医疗保健，以及基于地点的因素(“当前地点效应”)，这是 与他们目前所处位置相关的环境，我们希望收集到的发现不仅将大大丰富 我们对影响老年人健康行为和健康的因素的认识，也对老年人的健康状况有一定的启示作用 旨在改善老年人健康行为和健康的替代政策的可能效果。 为了实现这一目标，该提案有三个核心目标。在目标1中，我们重点关注一种特定的、有害的 健康行为：阿片成瘾。老年人口使用处方阿片类药物的比率比任何人都高 因此，这表明这一危机在老年人中是严重的，并可能随着近 老年人继续变老。通过分析特定人的因素，如精神健康状况和既往 药物滥用，以及特定地点的因素，包括是否有医生愿意开处方 阿片类药物，因为他们认为合法的理由或存在的政策，如处方监测 旨在限制滥用的计划，我们希望能更好地了解阿片类药物的两种原因 危机以及旨在应对危机的政策可能产生的影响。 在拟议的更新的第二部分，我们将超越经验方法 在目标1中使用，以两种具体方式关注基于地点的因素的作用。在目标2中，我们将分析 地点因素对老年人死亡率的影响。在目标3中，我们将分析基于地点的因素的作用 这是造成老年人口健康差距的主要原因。重要的是要了解 当前地点效应和个人因素对老年人死亡率和老年人死亡率的影响 差异，以便更充分地了解可能导致老年人死亡的因素和可能的影响 关于老年人健康的政策。通过这些目标，我们希望更清楚地了解人是如何-- 年老年人健康行为和健康结局受特定因素和地点因素的影响 美国。

PROJECT SUMMARY/ABSTRACT Determinants of Elderly Health: The Role of Place-Based Factors The goal of the proposed research is to better understand the factors affecting the health and health behaviors of the elderly population in the United States by moving beyond the work of the prior grant, which aggregated analysis of elderly healthcare utilization, to look directly at health behaviors and health outcomes. As recent work has shown, there are large disparities in life expectancy among the Medicare population by race, income, and geography, despite access to the same universal health insurance program. By examining two potential broad-based forces, person-specific factors (“health capital”), which can include genetic endowments as well as prior medical care, and place-based factors (“current place effects”), which is the environment associated with their current location, we hope to gather findings that will greatly enrich not only our understanding of the factors that affect the elderly’s health behaviors and health, but also shed light on the likely efficacy of alternative policies aimed at improving elderly health behaviors and health. To accomplish this goal, the proposal has three central Aims. In Aim 1, we focus on a specific, harmful health behavior: opioid addiction. The elderly population uses prescription opioids at a higher rate than any other age group, therefore suggesting that this crisis is acute among the elderly and may worsen as the near- elderly continue to age. By analyzing person-specific factors, such as mental health status and prior substance abuse, as well as place-specific factors, including availability of physicians willing to prescribe opioids for what they perceive as legitimate reasons or the presence of policies such as prescription monitoring programs intended to limit abuse, we hope to gain a better understanding of both the causes of the opioid crisis and the likely impacts of policies designed to combat it. In the second part of the proposed renewal, we will extend beyond the empirical methodology employed in Aim 1 to focus on the role of place-based factors in two specific ways. In Aim 2, we will analyze the impact of place-based factors on elderly mortality. In Aim 3, we will analyze the role of place-based factors in contributing to health disparities among the elderly population. It is critical to understand the relative roles of current place effects and person-specific factors in contributing to elderly mortality and elderly mortality disparities in order to more fully understand the factors that may lead to elderly mortality and the likely effects of policies on elderly health. Through these aims we hope to gain a clearer understanding of how person- specific and place-specific factors affect the health behaviors and health outcomes of the elderly population in the United States.