2015 APHA Annual Meeting & Expo

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Online Program

338655
Social services expenditures and diabetes outcomes among older adults


Tuesday, November 3, 2015 : 1:30 p.m. - 1:50 p.m.

Erika Rogan, MSc, Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
Elizabeth Bradley, MBA, PhD, Health Policy, Yale School of Public Health, New Haven, CT
Background: More than 25% of Americans aged 65 years and older have diabetes. By 2025, nearly 2.5 million older adults are expected to suffer from visual impairments related to the disease, leading to an additional 1.5 billion dollars in annual medical costs. Research suggests that investments in non-medical services (e.g., transportation, nutrition) may benefit health, but few studies have explored their role in older adult health outcomes. The Older Americans Act (OAA) allocates funding to states to provide social services to older adults; we exploit variation in state expenditures to assess the relationship between social services spending and diabetes-related outcomes.

Methods: We conducted multivariable logistic regression to estimate associations between state OAA expenditures (AGing Integrated Database) and older adult diabetes-related outcomes (Behavioral Risk Factor Surveillance System) for 2005-2009. Models were adjusted for individual demographic factors and state-level characteristics, including Medicare spending. Time fixed effects and robust standard errors were also incorporated.

Results: OAA spending per 1,000 older adults ranged from $14,200 to $102,500 across states. Increases in total OAA expenditures were associated with lower likelihood of ever being diagnosed with diabetes  (p<.001) after adjusting for covariates. This association remained significant when nutrition (p<.001) and transportation (p<.05) expenditures were analyzed separately. Associations between OAA expenditures and diabetic retinopathy were not statistically significant.

Conclusions: These findings demonstrate the potential for non-medical investments to support diabetes prevention for older adults, but suggest that these expenditures may not be as protective for complications of existing disease.

Learning Areas:

Public health or related public policy
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess the association between state-level Older Americans Act expenditures and diabetes-related outcomes among adults aged 65 years and older. Identify two social service categories for which increased expenditures are protective for older adult diabetes outcomes.

Keyword(s): Public Policy, Aging

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a pre-doctoral trainee on the federally-funded AHRQ-Yale T32 Training Grant for Health Services Research. My research focuses on the role of non-medical factors (e.g., social services) in health outcomes of adults aged 65 years and older, and the variation in state-level approaches to improving older adult health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4202.0: Vision and Aging (A Collaborative Session with the Aging & Public Health and Vision Care Sections)