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Executive BriefIntroductionKey FindingsSocial and Economic FactorsPhysical EnvironmentClinical CareBehaviorsHealth OutcomesState Summaries
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
US SummaryAppendixMeasures TableData Source DescriptionsThe Team
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixMeasures TableData Source DescriptionsThe TeamPrior to the COVID-19 pandemic, seniors across the country experienced some improvements in measures of access to quality health care and preventive services, reflected in an increase in flu vaccination rates and a decrease in the number of preventable hospitalizations. Also, the number of geriatric providers increased between 2018 and 2020.
Geriatric providers
Definition: Number of family medicine and internal medicine geriatricians and geriatric nurse practitioners per 100,000 adults ages 65 and older.
In 2020, there were 30.1 geriatric providers per 100,000 adults ages 65 and older, an increase of 13% since 2018 (26.7 providers per 100,000). This was a positive development for the health of older adults. Compared with standard care, seniors receiving care in specialized geriatric units have better function at the time of discharge, and rehabilitative services involving geriatricians result in lower nursing home admissions and improved function at follow-up.
The number of geriatric providers varied widely by state. In 2020, the number of geriatric providers per 100,000 adults ages 65 and older was 5.3 times higher in Rhode Island (57.7 providers per 100,000) than in North Dakota (10.8). Geriatric providers had a moderate negative correlation with rural population (r=-0.47), meaning states with a larger rural population tended to have a lower number of geriatric providers.
Rural population
Rural areas are often under-resourced and face unique challenges regarding access to clinical care, including preventive services and specialty care according to the Association of American Medical Colleges. These challenges may lead to increased morbidity and mortality. In 2019, an estimated 18.7% of the U.S. population lived in a rural area. The estimate varied from 5.0% in California to 60.9% in Maine. Vermont and West Virginia also had estimated rural populations above 50%.
Flu vaccination
Definition: Percentage of adults ages 65 and older who reported receiving a seasonal flu vaccine in the past 12 months.
In 2019, 63.8% of adults ages 65 and older reported receiving a seasonal flu vaccination, a 6% increase since 2017 from 60.4%. The rate among older adults was higher than the national flu vaccination rate among adults ages 18 and older at 43.7%. This is promising since older adults are at increased risk of getting serious complications from the flu according to the CDC.
Flu vaccination rates among older adults were highest in North Carolina (71.1%) and Connecticut (70.0%). Among their older adult populations, both states reached or surpassed the U.S. Department of Health and Human Services’ Healthy People 2030 target of 70% vaccination among all persons ages 6 months and older, though neither state has reached the target for their overall population.
Between 2017 and 2019, flu vaccination rates significantly increased in 17 states, led by Wisconsin (52.7% to 63.9%) and Massachusetts (57.5% to 67.6%).
Flu vaccination varied by state, race and ethnicity, education and income. In 2019, flu vaccination among adults ages 65 and older was:
- 1.2 times higher among college graduates (70.6%) than those with less than a high school education (56.9%); the prevalence significantly increased with each increase in education level.
- 1.2 times higher among those with an annual household income of $75,000 or more (70.0%) than those with an income less than $25,000 (57.7%); the prevalence significantly increased with each increase in income level.
Adults ages 65 and older are making progress toward the Healthy People 2030 target to vaccinate 70% of those ages 6 months and older.
Preventable hospitalizations
Definition: Discharges following hospitalization* per 100,000 Medicare beneficiaries ages 65-74 enrolled in the fee-for-service program.
* Applies for diabetes with short- or long-term complications, uncontrolled diabetes without complications, diabetes with lower extremity amputation, chronic obstructive pulmonary disease, angina without a procedure, asthma, hypertension, heart failure, dehydration, bacterial pneumonia or urinary tract infection.
In 2018, the rate of preventable hospitalizations was 2,358 hospitalizations per 100,000 Medicare beneficiaries ages 65-74, a decrease of 6% since 2017 (2,504 hospitalizations per 100,000). Preventable hospitalizations may lead to additional morbidity and mortality, loss of functional abilities and increased health care expenditure for long-term care. The number of potentially preventable hospitalizations reflects the quality of primary care and use of primary care outpatient services. West Virginia, Mississippi, Kentucky, Alabama, Louisiana, Minnesota and Oklahoma had preventable hospitalization rates of more than 3,000 hospitalizations per 100,000 Medicare beneficiaries ages 65-74.
Between 2017 and 2018, preventable hospitalizations decreased in 47 states and the District of Columbia. The largest decreases occurred in Kentucky (3,924 to 3,538 hospitalizations per 100,000), the District of Columbia (3,559 to 3,217), Michigan (3,247 to 2,925) and Minnesota (3,434 to 3,125). All of these decreases were more than 300 hospitalizations per 100,000. On the other hand, Nevada, Utah and Wyoming experienced slight increases.
Preventable hospitalizations varied widely by state and race and ethnicity. In 2018, the rate of preventable hospitalizations per 100,000 Medicare beneficiaries ages 65-74 was:
- 4.1 times higher among Black (4,419 hospitalizations per 100,000) and 3.8 times higher among American Indian/Alaskan Native (4,084) than Asian/Pacific Islander (1,085) Medicare beneficiaries.
The preventable hospitalizations rate was 2,358 hospitalizations per 100,000 Medicare beneficiaries ages 65-74, a decrease of 6% since 2017.
