医疗保险按服务收费受益人群中的虚弱、社会剥夺与死亡率
Frailty, social deprivation, and mortality among Medicare fee-for-service beneficiaries.
作者信息
Zhong Lily, Sison Stephanie Denise M, Cheslock Megan, Liu Yuchen, Newmeyer Natalie, Kim Dae Hyun
机构信息
University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2025 May;73(5):1535-1541. doi: 10.1111/jgs.19318. Epub 2024 Dec 16.
BACKGROUND
The geographic distribution of frailty and social deprivation, and their association with mortality in the United States, have not been well studied.
METHODS
We estimated claims-based frailty index (CFI) (range: 0-1) and area-level social deprivation index (SDI) (range: 0-100) in a 5% random sample of 1,207,323 Medicare fee-for-service beneficiaries 65 years and older. We examined the prevalence of frailty (defined as CFI ≥ 0.25) and the mean SDI and estimated their correlation by state and county. The association of frailty and social deprivation with one-year mortality was estimated using logistic regression, adjusting for age, sex, and dual eligibility status.
RESULTS
The study population had the following characteristics: mean age of 76 years, 56% female, 10.3% with frailty, and 24.0% with high social deprivation (SDI ≥ 67). The correlation between frailty and social deprivation was weak (ρ = 0.39 by state and 0.28 by county). The risk of death for the total study population was 4.5%. The age, sex, dual eligibility, and SDI-adjusted risk of death for robust, pre-frail, and frail individuals was 1.8%, 4.4%, and 13.3%, respectively. The age, sex, dual eligibility-adjusted risk of death for low, medium, and high SDI regardless of frailty was 4.4%, 4.7%, and 4.6%, respectively. In robust beneficiaries, the adjusted risk of death for low, medium, and high social deprivation was 1.6%, 1.9% (odds ratio [OR]: 1.21 [95% confidence interval, CI: 1.15, 1.27]), and 2.0% (1.31 [1.24, 1.38]), respectively, whereas in beneficiaries with frailty, the corresponding risk by social deprivation was 13.4%, 13.7% (1.03 [0.99, 1.07]), and 12.9% (0.96 [0.92, 1.00]).
CONCLUSION
This study identifies regions of the United States that may be most vulnerable from frailty and social deprivation. These findings emphasize the significance of frailty and social deprivation on mortality and the need for community-based preventative health programs such as frailty screening to improve health outcomes for Medicare beneficiaries living with frailty.
背景
在美国，衰弱和社会剥夺的地理分布及其与死亡率的关联尚未得到充分研究。
方法
我们在1207323名65岁及以上的医疗保险按服务收费受益人的5%随机样本中，估计了基于索赔的衰弱指数（CFI）（范围：0 - 1）和地区层面的社会剥夺指数（SDI）（范围：0 - 100）。我们按州和县检查了衰弱的患病率（定义为CFI≥0.25）以及平均SDI，并估计了它们之间的相关性。使用逻辑回归估计衰弱和社会剥夺与一年死亡率的关联，并对年龄、性别和双重资格状态进行了调整。
结果
研究人群具有以下特征：平均年龄76岁，女性占56%，衰弱者占10.3%，社会剥夺程度高者（SDI≥67）占24.0%。衰弱与社会剥夺之间的相关性较弱（按州ρ = 0.39，按县ρ = 0.28）。整个研究人群的死亡风险为4.5%。身体健壮、衰弱前期和衰弱个体在调整年龄、性别和双重资格后的死亡风险分别为1.8%、4.4%和13.3%。无论是否衰弱，SDI低、中和高组在调整年龄、性别和双重资格后的死亡风险分别为4.4%、4.7%和4.6%。在身体健壮的受益人中，社会剥夺程度低、中和高组调整后的死亡风险分别为1.6%、1.9%（优势比[OR]：1.21[95%置信区间，CI：1.15，1.27]）和2.0%（1.31[1.24，1.38]），而在衰弱的受益人中，相应的社会剥夺风险分别为13.4%、13.7%（1.03[0.99，1.
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