title: Geographical variation in health-related quality of life among older US adults, 1997-2010.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) is an important predictor of morbidity and mortality; however, its geographical variation in older adults in the United States has not been characterized. We compared HRQOL among older adults in the 50 US states and the District of Columbia using the Health and Activities Limitation Index (HALex). We also compared the HRQOL of 4 regions: South, West, Midwest, and Northeast.
  
  
  METHODS
  We analyzed pooled data from 1997 through 2010 from the National Health Interview Survey for participants aged 65 or older. HALex scores (which range from 0 to 1.00, with higher values indicating better health) were calculated by combining data on participants' perceived health and activity limitations. We ranked states by mean HALex score and performed multivariable logistic regression analyses to compare low scores (defined as scores in the lowest quintile) among US regions after adjustment for sociodemographics, health behaviors, and survey design.
  
  
  RESULTS
  Older residents of Alaska, Alabama, Arkansas, Mississippi, and West Virginia had the lowest mean HALex scores (range, 0.62-0.68); residents of Arizona, Delaware, Nevada, New Hampshire, and Vermont had the highest mean scores (range, 0.78-0.79). Residents in the Northeast (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.57-0.76) and the Midwest (OR, 64; 95% CI, 0.56-0.73) were less likely than residents in the South to have scores in the lowest quintile after adjustment for sociodemographics, health behaviors, and survey design.
  
  
  CONCLUSIONS
  Significant regional differences exist in HRQOL of older Americans. Future research could provide policy makers with information on improving HRQOL of older Americans.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Room 1073, Miami, FL 33136. E-mail: dkachan@med.miami.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Kachan
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Olano
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: William G
authors.initials: WG
authors.lastname: LeBlanc
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Laura A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data*; D015438:Health Behavior / Q000208:ethnology; D006305:Health Status Indicators; D006306:Health Surveys; D040361:Healthy People Programs; D006801:Humans; D008019:Life Style; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009043:Motor Activity; D016017:Odds Ratio; D011159:Population Surveillance; D011788:Quality of Life; D012044:Regression Analysis; D012111:Residence Characteristics; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D014481:United States / Q000453:epidemiology