2022 International Conference on Aging in the Americas

Abstract

Background: Research comparing healthcare costs by geographic context has primarily been conducted outside the U.S. and has overlooked Latinxs and comparisons by dementia status. Given that Latinxs have a greater risk and earlier onset of dementia relative to Whites, assessing rural-urban-dementia disparities in healthcare costs is critical to address burden of disease and to inform tailored points of intervention. We compared healthcare costs across rural and non-rural contexts among Latinxs and examined whether differences vary by dementia status. Methods: Data are from a nationally representative sample of Latinx adults ages 51+ (n = 15,567) in the Health and Retirement Study (2006-2018 waves). Healthcare costs were inflated using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. The Langa-Weir algorithm determined dementia status. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. Results: Higher total healthcare costs were found in rural areas regardless of dementia status. The total cost of care was estimated to be $752 greater in rural ($2,580) compared to non-rural ($1,828) areas (95% CI: 10.43-1,463). Larger hospitalization and office visit costs drove the higher costs in rural areas. Likewise, the out-of-pocket costs of care were $771 (2,613 vs. 1,842; 95% CI: 49.16-1492.17) higher in rural areas. Dementia status did not significantly moderate the geographic context-healthcare costs relationship. Discussion: Findings identify disproportionately higher healthcare costs among Latinxs living in rural areas, relative to their non-rural counterparts. As Latinxs are the largest ethnic minoritized population in the U.S. and Latinx communities are growing in rural America, addressing the burden of dementia and healthcare costs among Latinxs in rural areas is a public health priority. Mobilizing providers, promotoras, and resources to address these disparities is critical to promote healthy aging and resilience among this population.