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

Key Points Question Is social, cultural, and community engagement (SCCE) associated with subsequent health care utilization among older adults in the US? Findings In this cohort study of 12412 US older adults, more frequent SCCE was associated with lower inpatient and community health care utilization but more interaction with outpatient and dental care in 2 years of follow-up. Longitudinally, compared with consistent engagement, individuals with decreased SCCE were more likely to use inpatient care but had fewer outpatient and dental care visits at 6 years of follow-up. Meaning These findings suggest that SCCE may have a protective association in shaping beneficial early and preventive health care-seeking behavior and potentially facilitate the decentralization of the health care system, reducing demand for inpatient and community health care. This cohort study assesses associations of social, cultural, and community engagement and health care utilization among older US adults. Importance There 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. Objective To examine the associations between SCCE and health care utilization. Design, Setting, and Participants This 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. Exposures SCCE 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). Results A total of 12412 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 Relevance These 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.

Automated summary

This study examines the association between social, cultural, and community engagement (SCCE) and health care utilization among older adults. The findings indicate that more frequent SCCE is associated with lower inpatient and community health care utilization, but more interaction with outpatient and dental care. Longitudinally, decreased SCCE is associated with increased inpatient care but fewer outpatient and dental care visits.