Massachusetts Healthy Aging Data Report Shows Powerful Effects of Income, Education and Other Factors on Population Health
- Income and education levels had more influence than any other variable on community population health
- Major racial disparities persist in a range of health-related outcomes
- Healthy behaviors and preventive services make a difference in healthy aging
- Population health is much higher or lower than expected in a few Massachusetts communities
WATERTOWN, MA – March 18, 2015 – The Tufts Health Plan Foundation today released the results of its second edition of the Massachusetts Healthy Aging Data Report: Community Profiles 2015. Thirty-nine new indicators of health have been added and in-depth, sophisticated data analyses conducted to provide the “big picture” about the health of older citizens in each of the 351 cities and towns of Massachusetts as well as the 16 neighborhoods of Boston.
The data will be presented today at Building Age-Friendly Communities: The Summit, which is hosted by the Tufts Health Plan Foundation in partnership with The Boston Foundation. To view the 2015 Highlights Report, each of the 367 Community Profiles and more than 100 statewide health indicator maps, visit the Massachusetts Healthy Aging Collaborative website. You can also view an infographic of the data.
Each Community Profile includes 121 indicators of individual and community health designed to help residents, agencies, providers and governments understand the older adults who live in their cities and towns – their ages, living arrangements, health status, strengths and vulnerabilities. Each indicator is listed alongside state averages, allowing for a comparison of how a town is doing relative to the rest of the state by each variable.
In addition to the new health indicators, the 2015 Highlights Report explores racial disparities and includes a new composite measure – the Serious Complex Chronic Disease measure – which distills 40 chronic disease indicators found to be positively associated with higher mortality rates. This measure is used to identify those communities that are most and least healthy. In addition, other multivariate analyses allowed for a deeper exploration of the data to identify factors that explain variations in health within communities, and find communities with “better” or “worse” population health than what is statistically expected, given the attributes of the older adults living in those communities.
“We see these data and additional analyses as critical to understanding what is happening in our communities and identifying ‘winnable battles,’ where significant progress can be made in improving health outcomes in a relatively short time frame,” said Nora Moreno Cargie, vice president corporate citizenship for Tufts Health Plan and executive director of the Tufts Health Plan Foundation. “We need changes in policies and priorities, including interventions and engagement of others, to develop supportive social systems and physical environments that lead to age-friendly communities. Importantly, it is work we need to do collaboratively.”
Key insights into the health of our state as it relates to older adults:
Income and education levels had more influence than any other variable on the variation observed across Massachusetts communities. Communities with less educated, poorer and older residents tend to have worse health, suggesting that, to some extent, healthy aging is a social justice issue.
Healthy behaviors make a difference. Older adult population health tends to be better in communities with the highest levels of good health behaviors and preventive service use, and in communities with better social environments as reflected in lower crime rates and higher voter participation rates.
Population health is much higher or lower than expected in a few Massachusetts communities, despite the powerful influences of income and education levels. These communities may provide lessons about both more-effective and less-effective strategies for improving public health.
Major racial disparities persist in a range of health-related outcomes. However, other things being equal, communities that are more racially diverse and have acculturated populations tend to have better health. Findings include:
- Older black and Hispanic men report poorer health, lower levels of emotional support, and being less likely to engage in healthy behaviors than older white men.
- Older black and Hispanic men are more likely than older white men to suffer from hypertension, diabetes, kidney disease, and glaucoma, but older white men had higher rates for other chronic conditions such as osteoporosis, hip fracture, and Chronic Obstructive Pulmonary Disease.
- Older minority women have major disparities compared to older white women. Black and Hispanic older women report higher rates for most heart conditions (stroke, heart attacks, congestive heart failure, high blood pressure), disability and obesity compared to older white women.
- Older black and Hispanic women also had lower rates of engaging in healthy behaviors (e.g., seeing a doctor because of cost, getting yearly vaccinations or dental exams, participating in physical activity) compared to older white women.
- Older Asian adults generally appear much healthier than their non-Asian counterparts, having the lowest diagnosed prevalence rates for nearly all chronic diseases except diabetes (both men and women) and osteoporosis (women only).
One way the researchers attempted to better understand these disparities was to compare statewide data from the Behavioral Risk Factor Surveillance Survey (BRFSS) and Centers for Medicare and Medicaid Services (CMS) on health indicators by racial group after statistically controlling for socio-economic status.
“When we did this analysis, the racial differences in healthy aging indicators were greatly reduced,” said Elizabeth Dugan, PhD, principal investigator for this report at the Gerontology Institute, University of Massachusetts Boston. “That means it is not the color of one’s skin that is driving health disparities, but the social determinants of health – education, income levels and living situations of individuals – that matter.”
The 39 new health indicators in the 2015 Community Profiles expand upon the previous individual and community level characteristics. At the individual level, indicators were added to capture new estimates for people age 60 years or older, non-native English speakers, veterans and others, as well as eight new chronic disease states including asthma and high cholesterol, and disability indicators. At the community level, new indicators provide information on access to care as well as physical and social environment factors such as air pollution and voter registration, traffic fatalities involving older adults, and household income and poverty measures.
About the Massachusetts Healthy Aging Data Report
The Massachusetts Healthy Aging Data Report: Community Profiles is intended to expand the conversation about healthy aging for a broad audience of community, service, thought and policy leaders in the Commonwealth. The goal is to assess the health status of the Massachusetts older adult population at a sufficiently local level to be actionable for the purposes of targeted interventions.
The report was commissioned by the Tufts Health Plan Foundation with research led by Elizabeth Dugan, PhD, Frank Porell, PhD and Nina M. Silverstein, PhD from the Gerontology Institute of the John W. McCormack Graduate School of Policy and Global Studies at the University of Massachusetts Boston. The report uses data of older adults age 60+ and 65+ from three main sources: U.S. Census, Behavioral Risk Factor Surveillance Survey (BRFSS) and Centers for Medicare and Medicaid Services (CMS). To view the Highlights Report, each of the 367 Community Profiles and interactive maps, please visit the Massachusetts Healthy Aging Collaborative website.