The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries
Open accessAbstract
IMPORTANCE: A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status. OBJECTIVE: To evaluate the association between income and risk of becoming homebound. DESIGN: Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING: Population‐based study in the United States. PARTICIPANTS: A total of 7,042 initially nonhomebound community‐dwelling older adults. EXPOSURE: Total annual household income at baseline (in 2011) measured via self‐report. OUTCOME: Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less. RESULTS: Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20–2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile. CONCLUSION AND RELEVANCE: Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Being single, financially impoverished, and socially isolated are risk factors for being homebound.
“Being single, financially impoverished, and socially isolated are risk factors for being homebound 4 and disproportionately more common among LGBTQ + older populations.”
From Caring for LGBTQ+ Older Adults at Home (2023) · cites this paper as [4]
The Results (page unavailable) identify low income as a significant predictor of becoming homebound. Marital status and social isolation appear as adjustment variables, but the cited passages do not establish that being single or socially isolated are themselves risk factors. The citation is attached to the risk-factor clause, not the subsequent claim about LGBTQ+ older populations. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Fine, J. P., & Gray, R. J. (1999) · Journal of the American Statistical Association · doi:10.1080/01621459.1999.10474144 · Cited by 14,290 · see citing works
The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000093487.78664.3c · Cited by 6,359 · see citing works
The Association Between Income and Life Expectancy in the United States, 2001–2014
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016) · JAMA · doi:10.1001/jama.2016.4226 · Cited by 2,812 · see citing works
Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century
Case, A., & Deaton, A. (2015) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1518393112 · Cited by 2,759 · see citing works
Practical recommendations for reporting F ine‐ G ray model analyses for competing risk data
Austin, P. C., & Fine, J. P. (2017) · Statistics in Medicine · doi:10.1002/sim.7501 · Cited by 1,299 · see citing works
Lynch, J. W., Kaplan, G. A., & Shema, S. J. (1997) · New England Journal of Medicine · doi:10.1056/nejm199712253372606 · Cited by 869 · see citing works
Income inequality and health: pathways and mechanisms.
Kawachi, I. I., & Kennedy, B. P. (1999) · PubMed Central · Cited by 697 · see citing works
Predictors of nursing home admission for persons with dementia
Gaugler, J. E., Yu, F., Krichbaum, K., & Wyman, J. F. (2009) · Medical Care · doi:10.1097/mlr.0b013e31818457ce · Cited by 617 · see citing works
Validity and reliability of the AD8 informant interview in dementia
Galvin, J. E., Roe, C. M., Xiong, C., & Morris, J. C. (2006) · Neurology · doi:10.1212/01.wnl.0000247042.15547.eb · Cited by 495 · see citing works
A nuanced understanding of Internet use and non-use among the elderly
van Deursen, A. J. A. M., & Helsper, E. J. (2015) · European Journal of Communication · doi:10.1177/0267323115578059 · Cited by 407 · see citing works
Epidemiology of the Homebound Population in the United States
Ornstein, K. A., Leff, B. A., Covinsky, K. E., Ritchie, C. S., Federman, A. D., Roberts, L., Kelley, A. S., Siu, A. L., & Szanton, S. L. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.1849 · Cited by 381 · see citing works
Self-citationThe Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life
Kelley, A. S., McGarry, K., Gorges, R., & Skinner, J. S. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0381 · Cited by 373 · see citing works
Self-citationYaffe, K., Falvey, C., Harris, T. B., Newman, A., Satterfield, S., Koster, A., Ayonayon, H., Simonsick, E., & Study, F. T. H. A. (2013) · BMJ · doi:10.1136/bmj.f7051 · Cited by 363 · see citing works
Loss to Follow-up in Cohort Studies
Howe, L. D., Tilling, K. M., Galobardes, B., & Lawlor, D. A. (2012) · Epidemiology · doi:10.1097/ede.0b013e31827623b1 · Cited by 311 · see citing works
Rising Out-Of-Pocket Spending For Chronic Conditions: A Ten-Year Trend
Paez, K., Zhao, L., & Hwang, W. (2009) · Health Affairs · doi:10.1377/hlthaff.28.1.15 · Cited by 297 · see citing works
US Prevalence And Predictors Of Informal Caregiving For Dementia
Friedman, E. M., Shih, R. A., Langa, K. M., & Hurd, M. D. (2015) · Health Affairs · doi:10.1377/hlthaff.2015.0510 · Cited by 227 · see citing works
Systematic Review of Outcomes from Home‐Based Primary Care Programs for Homebound Older Adults
Stall, N. M., Nowaczynski, M., & Sinha, S. K. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13088 · Cited by 226 · see citing works
Steenland, K., Goldstein, F. C., Levey, A. I., & Wharton, W. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-150778 · Cited by 226 · see citing works
A National Profile Of End-Of-Life Caregiving In The United States
Ornstein, K. A., Kelley, A. S., Bollens‐Lund, E., & Wolff, J. L. (2017) · Health Affairs · doi:10.1377/hlthaff.2017.0134 · Cited by 167 · see citing works
Self-citationHomebound older adults: Prevalence, characteristics, health care utilization and quality of care
Musich, S. A., Wang, S. S., Hawkins, K., et al. (2015) · Geriatric Nursing · doi:10.1016/j.gerinurse.2015.06.013 · Cited by 125 · see citing works
Friedman, S. M., Steinwachs, D. M., Rathouz, P. J., Burton, L. C., & Mukamel, D. B. (2005) · The Gerontologist · doi:10.1093/geront/45.2.157 · Cited by 119 · see citing works
Leff, B. A., Carlson, C. M., Saliba, D., & Ritchie, C. S. (2015) · Health Affairs · doi:10.1377/hlthaff.2014.1008 · Cited by 112 · see citing works
Financial Hardship and Mortality among Older Adults Using the 1996–2004 Health and Retirement Study
Tucker‐Seeley, R. D., Yi, L., Subramanian, S. V., & Sorensen, G. (2009) · Annals of Epidemiology · doi:10.1016/j.annepidem.2009.08.003 · Cited by 110 · see citing works
Soones, T. N., Federman, A. D., Leff, B. A., Siu, A. L., & Ornstein, K. A. (2016) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14467 · Cited by 95 · see citing works
Self-citationPsychiatric Status among the Homebound Elderly: An Epidemiologic Perspective
BRUCE, M. L., & McNamara, R. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb02103.x · Cited by 88 · see citing works
Symptom Burden in Chronically Ill Homebound Individuals
Wajnberg, A., Ornstein, K. A., Zhang, M., Smith, K. L., & Soriano, T. A. (2012) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12038 · Cited by 74 · see citing works
Self-citationNegrón-Blanco, L., de Pedro‐Cuesta, J., Almazán‐Isla, J., Rodríguez‐Blázquez, C., Franco, E., & Damián, J. (2016) · BMC Public Health · doi:10.1186/s12889-016-3270-z · Cited by 64 · see citing works
Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare
Reckrey, J. M., Yang, M., Kinosian, B. P., et al. (2020) · Health Affairs · doi:10.1377/hlthaff.2019.01537 · Cited by 58 · see citing works
Self-citationHome but still engaged: participation in social activities among the homebound
Szanton, S. L., Roberts, L., Leff, B., Walker, J. L., Seplaki, C. L., Soones, T., Thorpe, R. J., & Ornstein, K. A. (2016) · Quality of Life Research · doi:10.1007/s11136-016-1245-2 · Cited by 50 · see citing works
Self-citationRural Aging in America: Proceedings of the 2017 Connectivity Summit
Skoufalos, A., Clarke, J. L., Ellis, D., Shepard, V. L., & Rula, E. Y. (2017) · Population Health Management · doi:10.1089/pop.2017.0177 · Cited by 44 · see citing works
Desai, N. R., Smith, K. L., & Boal, J. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01641.x · Cited by 41 · see citing works
Medication Utilization in an Urban Homebound Population
Kronish, I. M., Federman, A. D., Morrison, R. S., et al. (2006) · The Journals of Gerontology Series A · doi:10.1093/gerona/61.4.411 · Cited by 37 · see citing works
Technology use by rural and urban oldest old
Calvert, J. F., Kaye, J. A., Leahy, M., Hexem, K. R., & Carlson, N. E. (2009) · Technology and Health Care · doi:10.3233/thc-2009-0527 · Cited by 36 · see citing works
Ornstein, K. A., Garrido, M. M., Bollens‐Lund, E., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.1636 · Cited by 34 · see citing works
Self-citationOrnstein, K. A., Smith, K. L., & Boal, J. (2009) · Journal of Applied Gerontology · doi:10.1177/0733464808329828 · Cited by 29 · see citing works
Self-citationFrequency of Leaving the House and Mortality from Age 70 to 95
Jacobs, J. M., Hammerman‐Rozenberg, A., & Stessman, J. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15148 · Cited by 29 · see citing works
Foverskov, E., Petersen, G. L., Pedersen, J. M., Rod, N. H., Mortensen, E. L., Brüünsgaard, H., & Lund, R. (2019) · European Journal of Ageing · doi:10.1007/s10433-019-00523-z · Cited by 23 · see citing works
Can Home‐Based Primary Care Drive Integration of Medical and Social Care for Complex Older Adults?
Leff, B. A., Lasher, A., & Ritchie, C. S. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15969 · Cited by 13 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Caring for LGBTQ+ Older Adults at Home
Robertson, M. L., Carnahan, J. L., & Streed, C. G. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08064-z · Cited by 5 · see citing works
- Authors
- Ornstein, K. A., Garrido, M. M., Bollens‐Lund, E., Reckrey, J. M., Husain, M., Ferreira, K. B., Liu, S. H., Ankuda, C. K., Kelley, A. S., & Siu, A. L.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Boston University (US)
- James J. Peters VA Medical Center (US)
- Corresponding author
- Ornstein, Katherine A.
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2020-08-10
- Volume
- 68
- Issue
- 11
- Pages
- 2594-2601
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC7722026
- OpenAlex
- W3048637396
- Semantic Scholar
- 5d1dbd8a23eaf4d035553731ff2502cf809e9dcf
- Cited by
- 31
- References
- 39
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 4
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K24AG062785, R01AG060967, U01AG032947)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- homebound status, household income, socioeconomic status, older adults, Medicare beneficiaries, community-dwelling older adults, income inequality, multimorbidity, functional disability, cognitive impairment, nursing home admission, competing risks
- MeSH terms
- Economic Status, Aged, Aged, 80 and over, Female, Medicare, Humans, Longitudinal Studies, Male, United States, Homebound Persons, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
