Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study

Abstract

ImportanceThere is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.ObjectiveTo examine the associations between SCCE and health care utilization.Design, Setting, and ParticipantsThis population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.ExposuresSCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).Main Outcomes and MeasuresHealth care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).ResultsA total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95% CI, 1.12-1.60) and dental care (OR, 1.73; 95% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95% CI, 0.44-0.60).Conclusions and RelevanceThese findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

Leisure engagement in older age is related to objective and subjective experiences of aging

“…Overall, 85% were of White race/ethnicity, 10% Black/African American, and 5% identified as Other race/ethnicities, 71% were married, and 48% were retired (Table S3 ). The HRS Social Engagement questionnaire measured participation in 15 leisure activities, which have previously been categorized into physical, creative, cognitive, and community activities 28 . The frequency of engagement in each domain ranged from 0 (never) to 6 (daily).…”

“…This scale included 18 consistent items across 2008 and 2010, three of which were excluded from this study (caring for sick or disabled adults, praying privately, using a computer for email, internet, or other tasks) as they were not typical leisure activities. This left 15 activities, which have previously been categorized into four domains: (a) physical activities (sport/exercise, walking), (b) creative activities (gardening, baking/cooking, needlework, and hobbies), (c) cognitive activities (reading, word games, cards or other games, and writing), and (d) community activities (volunteering, charity work, educational courses, sports or social clubs, non-religious organizations) 28 . Participants reported how frequently they engaged in each activity on a seven-point scale, from never (0) to daily (6).…”