Social Vulnerability of Older Adults and the Risk of Medical Hospitalization

项目总结/摘要 几十年的研究表明，老年人的社会决定因素会影响他们的健康，然而，我们缺乏方法， 运用这些知识。我们没有一个连贯的综合：什么基本的社会决定因素应该 研究者在他们的老龄化队列研究中包括了什么？一个负责任的医疗保健组织如何包括 社会决定因素，以确定在人口中的风险患者，他们负责？缺乏 实际上，为了纳入社会风险因素，风险模型往往排除社会风险因素，这样做， 有可能造成有偏见的估计。对于研究、人口健康和政策制定方面的实际应用， 有助于识别有效预测风险的社会决定因素的子集。之前的尝试都失败了， 没有考虑到老年人独特的社会决定因素。为了弥补这一差距，我们提出了一项研究， 制定一个社会脆弱性指数-反映老年人社会风险因素的一个概括衡量标准。 我们将测试社会脆弱性指数预测医疗住院这一常见健康事件的能力 在老年人中，并评估该指数改善传统风险模型的能力。核心假设 社会风险因素-特别是与衰老相关的社会风险因素-将显着改善 传统风险模型的预测模型判别。这一假设将被测试使用全国- 健康与退休研究医疗保险相关队列中老年人的代表性样本。我们有两 具体目标：（1）制定社会脆弱性指数，以预测医疗住院情况;（2）评估 社会脆弱性指数的能力，以改善传统的合并症为基础的预测模型。这 该项目具有创新性和重要性，因为它将制定一个社会脆弱性的简要衡量标准， 可以用来改善预测。这反过来将提高研究中使用的风险模型的质量， 人口健康和卫生政策。

Project Summary/Abstract Decades of research establish that social determinants of older adults affect their health, yet, we lack ways to implement this knowledge. We fall short without a coherent synthesis: What basic social determinants should an investigator include in their aging cohort study? How can a Medicare accountable care organization include social determinants to identify at-risk patients in the population for which they are accountable? Lacking practical ways to incorporate social risk factors, risk models often exclude social risk factors, and in doing so, risk creating biased estimates. For practical applications in research, population health, and policy settings it is useful to identify a subset for social determinants that predict risk efficiently. Prior attempts have fallen short by not accounting for the unique social determinant of older adults. To address this gap, we propose a study to develop a social vulnerability index – a summary measure reflective of the social risk factors of older adults. We will test the social vulnerability index’s ability to predict medical hospitalization, a common health event among older adults, and assess the index’s ability to improve traditional risk models. The central hypothesis is that social risk factors – specifically aging-associated social risk factors – will significantly improve the predictive model discrimination of traditional risk models. This hypothesis will be tested using the nationally- representative sample of older adults in the Health and Retirement Study Medicare-linked cohort. We have two specific aims: 1) Develop a social vulnerability index to predict medical hospitalization and 2) Assess the ability of the social vulnerability index to improve upon traditional comorbidity-based prediction models. This project is innovative and significant because it will develop a summary measure of social vulnerability that can be used to improve prediction. This will, in turn, will improve the quality of risk models used in research, population health, and health policy.