The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics.
Euijung Ryu, Chung-Il Wi, Philip H Wheeler and 4 others
PMID 36841262WHAT IT FOUND
Older adults with the lowest housing-based socioeconomic status had higher nursing home admission risk than those with the highest status, even after neighborhood deprivation was considered.
They were also more likely to live alone and struggle with daily activities.
Key findings
01After adjustment for age, sex, race/ethnicity and disease burden, the lowest housing-based socioeconomic quartile had a hazard ratio of 1.89 for nursing home admission compared with the highest quartile.
02After also adjusting for neighborhood area deprivation index, the lowest housing-based socioeconomic quartile had a hazard ratio of 1.81 compared with the highest quartile.
03Lower housing-based socioeconomic status was associated with living alone (odds ratio 6.35) and with difficulty in at least one daily activity (odds ratio 2.38).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study, so it cannot show that housing-based socioeconomic status caused nursing home placement. Some nursing home admissions may not have been captured if the person was not seen by the provider team. Important covariates could be missing, and missingness was more common in the lowest housing-based socioeconomic group. About 12% of the cohort had at least one missing variable, largely because socioeconomic measures needed address information. The study was limited to Olmsted County, Minnesota, and the authors say it generalizes to the upper Midwest, not necessarily elsewhere. The cohort was mostly non-Hispanic White, so the findings may not apply to other populations.
Declared interests
The funding and conflicts section says the authors declare no conflicts of interest. The article types list research support from NIH extramural and non-U.S. Gov't.
The easy way to misread this
Do not conclude that housing-based socioeconomic status causes nursing home placement or that changing housing will reduce risk. The study was observational and tested associations, not an intervention.