Dataset Information

The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

ABSTRACT: Importance: A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status.

Objective: To evaluate the association between income and risk of becoming homebound.

Design: Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65?years and older.

Setting: Population-based study in the United States.

Participants: A total of 7,042 initially nonhomebound community-dwelling older adults.

Exposure: Total annual household income at baseline (in 2011) measured via self-report.

Outcome: Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less.

Results: Over 7?years, 15.81% of older adults in the lowest income quartile (?$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20-2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile.

Conclusion and relevance: Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.

SUBMITTER: Ornstein KA

PROVIDER: S-EPMC7722026 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

Ornstein Katherine A KA Garrido Melissa M MM Bollens-Lund Evan E Reckrey Jennifer M JM Husain Mohammed M Ferreira Katelyn B KB Liu Shelley H SH Ankuda Claire K CK Kelley Amy S AS Siu Albert L AL

Journal of the American Geriatrics Society 20200810 11

<h4>Importance</h4>A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status.<h4>Objective</h4>To evaluate the association between inco ...[more]

PMID: 32776512

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Project description:ImportanceThe measured severity of illness of hospitalized Medicare beneficiaries has increased. Whether this change is associated with payment reforms, concentrated among hospitalizations with principal diagnoses targeted by payment reform, and reflective of true increases in severity of illness is unknown.ObjectivesTo assess whether the expansion of secondary diagnosis codes in January 2011 and the incentive payments for health information technology under the US Health Information Technology for Economic and Clinical Health Act were associated with changes in measured severity of illness and whether those changes are reflective of true increases in underlying patient severity.Design, setting, and participantsThis cohort study of Medicare fee-for-service beneficiary discharges (N = 47 951 443) between January 1, 2008, and August 31, 2015, used a regression-discontinuity design to evaluate changes in measured severity of illness after the expansion of secondary diagnoses. Discharge-level linear regression model with hospital fixed effects was used to evaluate changes in measured severity of illness after hospitals' receipt of incentives for health information technology. The change in predictive accuracy of measured severity of illness on 30-day readmissions after the implementation of both policies was evaluated. Data analysis was performed from November 1, 2018, to March 5, 2019.Main outcomes and measuresThe primary outcome was patients' measured severity of illness determined by the number of condition categories from secondary discharge diagnosis codes. Measured severity of illness for diagnoses commonly targeted by Medicare policies and untargeted diagnoses was assessed.ResultsIn total, 47 951 443 discharges at 2850 hospitals were included. In 2008, these beneficiaries included 3 882 672 women (58.5%) with a mean (SD) age of 78.5 (8.4) years. In 2014, the discharges included 3 377 137 women (57.8%) with the mean (SD) age of 78.4 (8.7) years. The Centers for Medicare & Medicaid Services expansion of secondary diagnoses was associated with a 0.348 (95% CI, 0.328-0.367; P < .001) change in condition categories for all diagnoses, 0.445 (95% CI, 0.419-0.470; P < .001) for targeted diagnoses, and 0.321 (95% CI, 0.302-0.341; P < .001) for untargeted diagnoses. Health information technology incentives were associated with a 0.013 (95% CI, 0.004-0.022; P = .005) change in condition categories for all diagnoses, 0.195 (95% CI, 0.184-0.207; P < .001) for targeted diagnoses, and -0.016 (95% CI, -0.025 to -0.007; P < .001) for untargeted diagnoses. Minimal improvements in predictive accuracy were observed.Conclusions and relevanceChanges in Centers for Medicare & Medicaid Services policies appear to be associated with increases in measured severity of illness; these increases do not appear to reflect substantive changes in true patient severity.

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Dataset Information

The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

Publications

The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

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