Yale researchers developed two indices—GERi-State and GERi-County—to measure how state and county-level conditions impact the health of older Americans.
Seniors living in the bottom 20% of these indices are at significantly higher risk for early mortality, frailty, dementia, and disability.
The indices focus on modifiable, policy-relevant variables like physician density, poverty rates, and tobacco taxes to inform targeted health interventions.
New research from Yale School of Medicine has identified how where older Americans live may directly influence their health and longevity. Two recently published studies, led by Dr. Robert Becher, reveal that geographic disadvantage, rooted in economic, social, and policy factors, can significantly increase the risk of death and disability among Americans aged 65 and older.
Becher and his team developed two novel indices to better understand these risks: the GERi-State index, which assesses health policy and socioeconomic disadvantage at the state level, and the GERi-County index, which captures multi-dimensional disadvantage at the county level.
These tools were designed using measurable, modifiable factors like preventable hospitalizations, median income, physician availability, and tobacco taxes.
Geography, not genetics
The researchers found that older adults living in the lowest 20% of both indices faced the greatest health threats. Specifically, those in disadvantaged counties had higher rates of frailty, dementia, and disability, as well as a 10% increased risk of premature death across two separate five-year periods.
Meanwhile, those in disadvantaged states showed an 11% to 14% increased risk of early mortality.
These findings underscore the idea that “place matters,” a theme Becher has observed in his surgical practice. “One of the most consistent findings in the medical literature is that place matters,” Becher said in a press release, noting that the built environment and policy context can serve as "fundamental determinants" of older adults’ health.
The research team, made up of experts from Yale’s School of Medicine, School of Public Health, and Faculty of Arts and Sciences, constructed the indices using data from 2006 to 2019 and focused on variables that policymakers could change. For instance, low physician density, high poverty rates, and suboptimal health policies were all linked to worse health outcomes.
Using these indices, the researchers identified 10 states and 627 counties across the U.S. as disadvantaged, with most of the affected states located in the South. Disadvantaged counties were more broadly dispersed, including in the South, Southwest, and Western U.S.