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

项目摘要 粮食不安全是一种未得到满足的社会需求，与健康状况较差和死亡率、发病率、健康状况 护理使用和卫生保健支出。在美国的老年人中，粮食不安全尤其令人关切 由于其最近的流行率上升及其与健康老龄化的障碍如营养素 缺陷、多种慢性病、功能限制、福尔斯和认知能力下降。越来越多 粮食不安全的老年人对卫生保健提供系统提出了额外的要求， 协调和全人护理，有效和高效地应对老年人的医疗需求 成年人及其社会背景。为了实现这一点，供应商需要严格的纵向证据来解决 粮食不安全对老年人保健需求、健康和保健的短期和长期影响 随着时间的推移，粮食不安全波动的后果，以及卫生保健的使用和病人的影响， 未来粮食不安全风险的特征。虽然关于粮食不安全和健康的研究越来越多， 绝大多数研究采用横断面设计或短期随访，没有捕获短暂的 粮食不安全的性质，也不是它与健康和保健之间的周期性和相辅相成的关系， 使用.此外，缺乏关于粮食不安全的纵向模式以及进入和退出粮食安全的过渡的证据。 老年人的粮食不安全，虽然粮食不安全在几个种族和族裔群体中更为普遍， 少数群体，很少有人知道粮食不安全对卫生保健结果的影响差异 在这些群体中。因此，提供者和卫生系统对何时、如何以及如何使用 粮食不安全导致健康和保健需求的变化。为了弥补这些知识差距， 拟议中的研究将利用五波健康和退休研究，一个全国性的代表， 对50岁及以上的社区居住老年人进行纵向调查，以说明食物的变化 随着年龄的增长，不安全感和医疗保健需求相互影响，并研究这些关系如何 在不同种族和民族群体之间存在差异。为了实现这些目标，该项目旨在（1）比较 在白色，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组，他们遵循不同的粮食不安全 轨迹以及与每个轨迹相关联的健康和健康护理结果;以及（3）估计 在低收入成年人中， 种族/民族身份、人口和社会经济特征、健康需求和医疗保健 经验这项研究将采用新的应用轨迹和过渡建模方法，以提高 关于粮食不安全与保健使用之间纵向关系的基本知识， 告知医疗保健提供系统能力的改善，以识别，预测和干预 粮食不安全的老年人的保健需求。

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.