TY - JOUR T1 - 1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD JF - Diabetes Y1 - 2020 A1 - Mukoso N. Ozieh A1 - Emma Garacci A1 - Rebekah J Walker A1 - Leonard E Egede KW - Diabetes Mellitus KW - Expenditures KW - Food security KW - Health Services Utilization KW - Kidney diseases KW - Medical Sciences–Endocrinology KW - Neighborhoods KW - Regression Analysis KW - Social interactions KW - United States–US AB - Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD). Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes. Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41). Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD. VL - 69 SN - 00121797 ER - TY - JOUR T1 - The contribution of dementia to the disparity in family wealth between black and non-black Americans JF - Ageing and Society Y1 - 2020 A1 - Jennifer Kaufman A1 - William T Gallo A1 - Fahs,Marianne C. KW - African Americans KW - Age KW - Aging KW - Alzheimer's disease KW - Alzheimers disease KW - Blacks KW - Costs KW - Dementia KW - dementia cost KW - Equity KW - Families & family life KW - Gerontology And Geriatrics KW - Health and Retirement Study KW - Income inequality KW - Long term health care KW - Ownership KW - Racial differences KW - Racial Disparities KW - Retirement KW - Senility KW - Studies KW - United States–US KW - Wealth KW - wealth disparities AB - {The enormous economic burden of dementia in the United States of America falls disproportionately on families coping with this devastating disease. Black Americans, who are at greater risk of developing dementia than white Americans, hold on average less than one-eighth of the wealth of white Americans. This study explores whether dementia exacerbates this wealth disparity by examining dementia's effect on wealth trajectories of black versus non-black Americans over an eight-year period preceding death, using five waves of data (beginning in 2002 or 2004) on decedents in the 2012 and 2014 waves of the Health and Retirement Study (N = 2,429). Dementia is associated with a loss of 97 per cent of wealth among black Americans, compared with 42 per cent among non-black Americans, while wealth loss among black and non-black Americans without dementia did not differ substantially (15% versus 19%). Dementia appears to increase the probability of wealth exhaustion among both black and non-black Americans, although the estimate is no longer significant after adjusting for all covariates (for blacks, odds ratio (OR) = 2.04, 95% confidence interval (CI) = 0.83, 5.00; for non-blacks VL - 40 SN - 0144686X IS - 2 ER - TY - NEWS T1 - Poverty report links wealth to life expectancy T2 - Prince George Citizen Y1 - 2019 KW - americans KW - Bernard KW - compounded KW - divide KW - General Interest Periodicals–United States KW - Home ownership KW - Households KW - Income distribution KW - Life Expectancy KW - Mongolia KW - Sanders KW - stark KW - survive KW - United States–US KW - Virginia KW - West Virginia AB - Poorer Americans are much less likely to survive into their 70s and 80s than rich Americans, a stark lifeexpectancy divide compounded by the nation's growing disparities in wealth, according to a U.S. report. Over three-quarters of the richest 50-somethings in 1991 were still alive 23 years later, in 2014, the report found. But among the poorest 20 per cent of that cohort, the survival rate was less than 50 per cent, according to the analysis by the Government Accountability Office, a nonpartisan congressional research agency. The report finds that while average life expectancy increased over that period, it "has not increased uniformly across all income groups, and people who have lower incomes tend to have shorter lives than those with higher incomes." JF - Prince George Citizen CY - British Columbia UR - https://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2292028778?accountid=14667 N1 - Name - Senate-Budget, Committee on the; Government Accountability Office; University of Chicago; University of Michigan; Copyright - Copyright Postmedia Network Inc. Sep 17, 2019; People - Sanders, Bernard; Last updated - 2019-09-18 ER -