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

项目总结/摘要 老年人健康的决定因素：基于场所的因素的作用 拟议研究的目标是更好地了解影响健康和健康的因素 老年人的行为在美国通过超越工作的事先赠款， 对老年人医疗保健利用情况进行汇总分析，以直接观察健康行为和健康结果。 最近的研究表明，医疗保险人群的预期寿命存在很大差异， 种族，收入和地理，尽管获得相同的全民健康保险计划。通过检查 两个潜在的广泛因素，个人特定因素（“健康资本”），其中可包括遗传因素， 禀赋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 环境与他们目前的位置，我们希望收集的发现，将大大丰富，不仅 我们对影响老年人健康行为和健康的因素的理解，也揭示了 旨在改善老年人健康行为和健康的替代政策的可能功效。 为了实现这一目标，该提案有三个中心目标。在目标1中，我们专注于一种特定的、有害的 健康行为：阿片成瘾。老年人使用处方阿片类药物的比例高于任何 因此，这表明这一危机在老年人中很严重，并可能随着年龄的增长而恶化。 老年人继续衰老。通过分析个人的具体因素，如心理健康状况和先前 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原因或存在处方监测等政策 通过旨在限制滥用的计划，我们希望更好地了解阿片类药物的两个原因 危机和旨在应对危机的政策可能产生的影响。 在建议更新的第二部分，我们将扩展到经验方法之外 在目标1中采用了这一方法，以两种具体方式重点关注基于地点的因素的作用。在第二章中，我们将分析 基于地点的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 造成老年人口的健康差距。关键是要了解的相对作用， 当前位置效应和个人特定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及其可能的影响 老年人健康政策。通过这些目标，我们希望能够更清楚地了解人- 特定和特定地点的因素影响老年人口的健康行为和健康结果， 美国的

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.