Abstract
There have been mixed findings on whether residential (spatial) age segregation causes better or worse health in older adults. These inconsistencies can possibly be attributed to two limitations in the previous studies. First, many studies have used statistical age composition to indicate the residential age segregation in a community, but this statistic does not consider the spatial arrangement of the residents. Second, many national scale studies have focused on averaged (or global) associations between age segregation and senior health and have assumed that these associations represent the situation in every part of a country. Little attention has been paid to local patterns of such association in different places. To address these previously identified limitations, we calculated a spatially explicit age segregation index for each United States (US) city to replace the conventional age composition index. We derived data regarding 92,560 respondents aged 65 and above in 185 US urban areas from the Behavioral Risk Factor Surveillance System (BRFSS). We then examined global and local associations between spatial age segregation and the self-rated health of older adults across US cities. Our multilevel global analysis suggested that older adults living in age-segregated metropolitan areas experienced more mentally unhealthy days. On the other hand, the local regression analysis identified local clusters of positive associations between the age segregation and the elderly’s overall health status in western and southern metropolitan areas, but no significant associations in midwestern and northeastern cities. In short, we advocated for the use of a spatially explicit approach to deepen the understanding of the association between age segregation and senior health. The new age segregation metric and new analytic approach can offer new insights into the ongoing debate regarding aging in place.
Highlights
The population of United State (US) is projected to become much older by 2030, with more than 20% of its residents being aged 65 years and above [1]
For the metropolitan and micropolitan statistical areas (MMSAs) level variables, we considered the spatially explicit age segregation index derived from Equation (2), along with the total population, total area, percentage of the population without a high school diploma, and percentage of the population in poverty
At the MMSA level, we found that the spatial age segregation was not significantly associated with the elderly’s general health status (GENHLTH) and had no association with the days of physically unhealthiness (PHYSHLTH) either
Summary
The population of United State (US) is projected to become much older by 2030, with more than 20% of its residents being aged 65 years and above [1]. Vogelsang and Raymo found that older adults experienced more disability and poorer functional health when living among a high proportion of other older adults [9] On the contrary, another group of researchers suggested that aging together benefits older adults by offering mutual support and feelings of safety, as well as the reduction of worry and the lessening of the effects of social isolation [10]. Moorman et al argued that the inconsistency possibly arises from the simple use of the proportion of older people to indicate age aggregation [6]. Many studies have used the conventional statistical method to test the averaged (global) associations of age segregation with senior health across a country Those averaged estimates might not be representative of the situation in any part of the country and may hide some very interesting and important local differences in the determinants of senior health. To the best of our knowledge, only three studies in the literature have evaluated the age segregation (not composition) index for US cities or counties [4,5,17], but none of them have linked their results to senior health
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