Research Shows Neighborhood Disadvantage Raises Risk of High Healthcare Costs, Especially for Older Adults

A recent study took a close look at how neighborhood-level social conditions impact the likelihood of people becoming high-cost healthcare utilizers. Published in the American Journal of Managed Care, the analysis examined a large sample of commercially insured individuals under age 65. It found some interesting connections between where people live and their healthcare spending.

While adding social determinants of health (SDOH) data didn't significantly improve the accuracy of predictive models, living in a disadvantaged neighborhood was linked to higher chances of incurring super high medical costs. This association was strongest for older adults aged 65 and up.

So what does this mean? It highlights the importance of addressing food access, transportation, and other social needs to better manage the health of Medicare Advantage members living in underserved communities.

On the flip side, for younger commercially insured people and children, living in a higher socioeconomic status neighborhood was actually tied to greater risk of being a high-cost user. This suggests that better access to healthcare in advantaged areas may be driving higher utilization and spending.

The big takeaway? Social determinants like income, education, and environment provide valuable insight into who may be at risk for accruing really high medical bills. This is crucial information for health plans and providers, even if SDOH data doesn't directly improve predictive model performance.

The study is insightful but does have some limitations to consider, like only looking at commercially insured individuals, using slightly outdated area-level SDOH estimates, and lacking race/ethnicity data. Additional research on specific conditions would be beneficial.

This study reveals the nuanced relationship between neighborhood disadvantage and high medical costs, and how this association varies across age groups. For example, older adults in underserved areas were more likely to have high expenses, while younger folks in higher socio economic status neighborhoods had greater risk. These results highlight the importance of health plans taking an individualized approach to members' health and social circumstances. Even though adding SDOH data didn't directly improve prediction accuracy, examining how socioeconomic factors link to medical spending is crucial for enhancing population health initiatives, particularly for vulnerable communities.