ArticleBMJ open2017
Burden of disease associated with lower levels of income among US adults aged 65 and older.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 13 citations in OpenAlex.
- The Effect of Medicaid Expansion on Racial/Ethnic and Gender Disparities in Access to Primary Care among Medicaid Patients.Journal of racial and ethnic health disparities · 2026Article
- Socioeconomic Factors Impact the Perception of Healthcare Experiences in Patients with Cirrhosis.Digestive diseases and sciences · 2026Article
- Change in self-reported health: A signal for early intervention in a medicare population.Healthcare (Amsterdam, Netherlands) · 2022Article
- Occupations and Sickness-Related Absences during the COVID-19 Pandemic.Journal of health and social behavior · 2022Article
- Low socioeconomic status worsens access to care and outcomes for rotator cuff repair: a scoping review.JSES reviews, reports, and techniques · 2022Article
- Preferred life expectancy and the association with hypothetical adverse life scenarios among Norwegians aged 60.Age and ageing · 2021Article
- At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function.Journal of racial and ethnic health disparities · 2019Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundPersons aged 65 years and older represent a heterogeneous group whose prevalence in the USA is expected to markedly increase. Few investigations have examined the total burden of disease attributable to lower levels of income in a single number that accounts for morbidity and mortality.
methodsWe ascertained respondents' health-related quality of life (HRQOL) scores and mortality status from the 2003 to 2004, 2005 to 2006, 2007 to 2008 and 2009 to 2010 cohorts of the National Health and Nutrition Examination Survey (NHANES) with mortality follow-up through 31 December 2011. A mapping algorithm based on respondents' age and answers to the 4 core Healthy Days questions was used to obtain values of a preference-based measure of HRQOL, the EuroQol five dimensions questionnaire (EQ-5D) index, which enables quality-adjusted life years (QALYs) to be calculated. We included only respondents aged 65 years and older at the baseline, yielding a total sample size of 4952. We estimated mean QALYs according to different categories of income based on the percentage of Federal Poverty Level (FPL).
resultsAfter adjusting for age, gender and education, the remaining QALYs decreased with each successive decrement of category of income, ranging from 18.4 QALY (≥500% FPL) to 8.6 QALY (<100% FPL). Compared with participants with a mean income of ≥250% FPL, participants with an income <250% FPL had significant losses in QALY for most of the sociodemographic groups examined. In contrast, persons with a lower educational attainment did not show a corresponding loss in QALY according to income category.
conclusionsThis study confirmed the association between lower income category and greater burden of disease, as measured by QALYs lost, among the US population aged 65 years and older. Our findings provide additional evidence of the role played by other key determinants of health and how factors not traditionally addressed by the healthcare system impact the life cycle of individuals and communities.
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