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Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

ABSTRACT: Objectives: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.Methods: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regression was used to examine the utilization of dental checkup, vision screening, influenza vaccination, and osteoporosis screening, using multiple numeracy level classifications.Results: A dichotomous classification of numeracy skill levels (low vs. moderate to high proficiency) was associated with dental checkup utilization, but vision screening, influenza vaccination, and osteoporosis screening.Conclusions: Middle-aged and older adults with sufficient numeracy skills are more likely to have had a dental check up in the past 12 months. Findings suggest that numeracy may be more relevant for long-term vs. short-term risk assessment in determining preventive health care service utilization.Clinical Implications: Two-level numeracy categories are recommended in preventive health contexts. Numeracy proficiency-sensitive risk communication by health care providers and education programs may enhance awareness of preventive health care and promote the utilization of specific preventive health service utilization among older adults.

SUBMITTER: Yamashita T

PROVIDER: S-EPMC6379140 | biostudies-literature | 2020 Mar-Apr

REPOSITORIES: biostudies-literature

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Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

Yamashita Takashi T Bardo Anthony R AR Millar Roberto J RJ Liu Darren D

Clinical gerontologist 20180507 2

<b>Objectives</b>: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.<b>Methods</b>: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regress ...[more]

PMID: 29733753

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Project description:Objective: Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults.Methods: We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200-400% of FPL), low-income (125-200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities.Results: The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37-0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33-0.38)] or receive counseling about diet modifications [0.77 (0.74-0.81)], exercise [0.81 (0.77-0.85)], or smoking cessation [0.71 (0.63-0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22-0.46)] or cholesterol [0.33 (0.26-0.42)] checked and receive counseling about exercise [0.84 (0.76-0.93)] or smoking cessation [0.78 (0.61-0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants.Conclusions: VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.

Project description:BackgroundChina has achieved nearly universal coverage of the Social Basic Medical Insurance (SBMI), which aims to reduce the disease burden and improve the utilization of health services. We investigated the association between China's health insurance schemes and health service utilization of middle-aged and older adults at different quantiles, and then explored whether the SBMI could help reduce the underutilization of health services among the middle-aged and older adults in China.MethodsSurvey data of middle-aged and older adults were drawn from the China Health and Retirement Longitudinal Study (CHARLS). A linear quantile mixed regression model was utilized to provide a comprehensive understanding of the relationship between SBMI and health service utilization, which was measured by the total medical expenditure. We took the New Rural Cooperative Medical Scheme (NCMS) as the reference level and examined the associations of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI) with health service utilization.ResultsThe quantile regression analysis revealed a significant positive association between URBMI and health service utilization at the 0.75 (??=?1.608, p?<?0.01), 0.8 (??=?1.578, p?<?0.01), 0.85 (??=?1.473, p?<?0.01), 0.9 (??=?1.403, p?<?0.01) and 0.95 (??=?1.152, p?<?0.01) quantiles, and also a significant positive association between UEBMI and health service utilization at the 0.85 (??=?1.196, p?<?0.01), 0.9 (??=?1.070, p?<?0.01) and 0.95 (??=?0.736, p?<?0.01) quantiles. Results showed that URBMI was significantly associated with an improvement in inpatient health service utilization of the middle-aged and older adults, and a significant positive association between UEBMI and inpatient health service utilization was observed at 0.1 (??=?0.559, p?<?0.01), 0.25 (??=?0.420, p?<?0.05), 0.5 (??=?0.352, p?<?0.05), and 0.75 (??=?0.306, p?<?0.05) quantiles.ConclusionsInequity in health service utilization exists among the middle-aged and older adults across urban and rural Chinese areas, and it can be explained by the different reimbursement benefits of SBMI types.

Project description:Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia.To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia.This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis. A total of 1?416?369 continuously enrolled, community-dwelling, fee-for-service Medicare beneficiaries 65 years or older with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012 were included.Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient's total visits are with fewer clinicians. Score range from 0 to 1 was examined in low-, medium-, and high-continuity tertiles.Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging, and laboratory testing (computed tomographic [CT] scan of the head, chest radiography, urinalysis, and urine culture), and health care spending (overall, hospital and skilled nursing facility, and physician).Beneficiaries with dementia who had lower levels of continuity of care were younger, had a higher income, and had more comorbid medical conditions. Almost 50% of patients had at least 1 hospitalization and emergency department visit during the year. Utilization was lower with increasing level of continuity. Specifically comparing the highest- vs lowest-continuity groups, annual rates per beneficiary of hospitalization (0.83 vs 0.88), emergency department visits (0.84 vs 0.99), CT scan of the head (0.71 vs 0.83), urinalysis (0.72 vs 1.09), and health care spending (total spending, $22?004 vs $24?371) were higher with lower continuity even after accounting for sociodemographic factors and comorbidity burden (P?<?.001 for all comparisons). The rate of ambulatory care sensitive condition hospitalization was similar across continuity groups.Among older fee-for-service Medicare beneficiaries with a dementia diagnosis, lower continuity of care is associated with higher rates of hospitalization, emergency department visits, testing, and health care spending. Further research into these relationships, including potentially relevant clinical, clinician, and systems factors, can inform whether improving continuity of care in this population may benefit patients and the wider health system.

Project description:Background:Excessive sedentary time is ubiquitous in Western societies. Previous studies have relied on self-reporting to evaluate the total volume of sedentary time as a prognostic risk factor for mortality and have not examined whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance. Objective:To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. Design:Prospective cohort study. Setting:Contiguous United States. Participants:7985 black and white adults aged 45 years or older. Measurements:Sedentary time was measured using a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Hazard ratios (HRs) were calculated comparing quartiles 2 through 4 to quartile 1 for each exposure (quartile cut points: 689.7, 746.5, and 799.4 min/d for total sedentary time; 7.7, 9.6, and 12.4 min/bout for sedentary bout duration) in models that included moderate to vigorous physical activity. Results:Over a median follow-up of 4.0 years, 340 participants died. In multivariable-adjusted models, greater total sedentary time (HR, 1.22 [95% CI, 0.74 to 2.02]; HR, 1.61 [CI, 0.99 to 2.63]; and HR, 2.63 [CI, 1.60 to 4.30]; P for trend < 0.001) and longer sedentary bout duration (HR, 1.03 [CI, 0.67 to 1.60]; HR, 1.22 [CI, 0.80 to 1.85]; and HR, 1.96 [CI, 1.31 to 2.93]; P for trend < 0.001) were both associated with a higher risk for all-cause mortality. Evaluation of their joint association showed that participants classified as high for both sedentary characteristics (high sedentary time [?12.5 h/d] and high bout duration [?10 min/bout]) had the greatest risk for death. Limitation:Participants may not be representative of the general U.S. population. Conclusion:Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, suggesting that physical activity guidelines should target reducing and interrupting sedentary time to reduce risk for death. Primary Funding Source:National Institutes of Health.

Project description:PURPOSE:The study aimed to assess the proportion of eye care service utilization and associated factors among older adults age ≥ 40 years in Hawassa city, South Ethiopia, June 2019. METHOD:A community-based cross-sectional study was conducted among adults aged 40 years and above who permanently live in Hawassa city from April 25 to May 30, 2019. Multistage sampling technique was used to select 704 participants. An interviewer-administered questionnaire was used to collect the data. The collected data was entered to EPI info version 7 & was analyzed by SPSS version 20. Binary logistic regression model was used to identify actual predictors of eye care service utilization. All variables were entered to multivariable analysis and variables with p-value < 0.05 were considered as statistically significant. RESULT:A total of 668 adults participated with a response rate of 94.9%. The median (±IQR) age of study respondents was 48(±10) years and 52.7% were females. The proportion of eye care service utilization within the past 2 years was found to be 23.8% [95% CI: 20.5%-27.1%]. Having history of eye disease [AOR = 9.8, 95% CI: 6.1-15.6], having awareness of regular eye checkup importance [AOR = 7.3, 95% CI:4.4-12.2], older age (age ≥65 years) [AOR = 5.0, 95% CI:1.9-13.3] and higher family monthly income (income ≥6000 ETB) [AOR = 3.0, 95% CI:1.5-5.7] and income 4001-5999 ETB [AOR = 2.9, 95% CI: 1.4-5.9] were positively associated with eye care service utilization. CONCLUSION AND RECOMMENDATION:The proportion of eye care service utilization among older adults in Hawassa city was low. Having a history of eye disease, having awareness about regular eye checkup importance, older age and higher family monthly income were significantly associated with utilization of eye care service. Therefore, it is recommended to provide eye health education for the community to increase awareness about eye care service utilization which can improve eye care service utilization.

Project description:ObjectiveTo examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.Data sourcesThe Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.Study designThis study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.Data collection/extraction methodsWe extracted longitudinal data from 2002 through 2018 waves of the HRS.Principal findingsExperiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.ConclusionsThe results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

Dataset Information

Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

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Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

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