Mortality rates for low-income older adults who are dually enrolled in Medicare and Medicaid are twice as high compared to those more affluent and solely enrolled in Medicare.

Researchers at Beth Israel Deaconess Medical Center, a patient care, teaching, and research affiliate of Harvard Medical School, recently conducted a study to evaluate how health outcomes have changed since the early 2000s for older adults who experience poverty and are dually enrolled in Medicare and Medicaid.

The study, published in early March in JAMA, included more than 71 million older adults insured by Medicare from 2004 and 2017. Researchers evaluated the change in annual death rates, hospitalization rates, and hospitalization-related deaths for those also dually enrolled in Medicaid due to poverty.

The findings indicate that disparities in health outcomes between these groups have not improved over time.

Low-income older adults dually enrolled in Medicare and Medicaid face social determinants of health issues such as poverty, housing instability, and limited access to health care. The findings from the study indicate that annual death rates for this subset of population are two times higher than those who are more affluent and non-dually enrolled, according to the researchers.

Other key findings include:

  • Annual hospitalization rates among dually enrolled adults were almost double that of those non-dually enrolled
  • 30-day and one-year death rates after hospitalization were higher for the low-income population
  • Disparities in health outcomes between the older and low-income adults have worsened in some cases
  • Annual death rates for low-income older adults were generally highest in Midwestern states, such as Indiana, Ohio, and Southeastern regions of the U.S. including Florida, Alabama, Arkansas, and the Carolinas

The health of the vulnerable and marginalized populations has been a significant focus for the U.S. policy and public health for more than a decade; however, additional efforts on a local and national scale are required to make a significant difference, according to researchers. "Our findings suggest that in order to improve health equity for this population, public health and policy efforts are needed to directly address social determinants of health and to provide support for safety-net health care systems that tend to care for low-income patients," said lead researcher Rishi Wadhera, M.D., MPP, MPhil, an investigator in the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, in a study announcement.