title: Challenges and barriers to health care and overall health in older residents of Alaska: evidence from a national survey.
abstract: BACKGROUND
  From 1970 to 2010, the Alaskan population increased from 302,583 to 698,473. During that time, the growth rate of Alaskan seniors (65+) was 4 times higher than their national counterparts. Ageing in Alaska requires confronting unique environmental, sociodemographic and infrastructural challenges, including an extreme climate, geographical isolation and less developed health care infrastructure compared to the continental US.
  
  
  OBJECTIVE
  The objective of this analysis is to compare the health needs of Alaskan seniors to those in the continental US.
  
  
  METHODS
  We abstracted 315,161 records of individuals age 65+ from the 2013 and 2014 Behavioral Risk Factor Surveillance System, of which 1,852 were residents of Alaska. To compare residents of Alaska to residents of the 48 contiguous states we used generalized linear models which allowed us to adjust for demographic differences and survey weighting procedures. We examined 3 primary outcomes - general health status, health care coverage status and length of time since last routine check-up.
  
  
  RESULTS
  Alaskan seniors were 59% less likely to have had a routine check-up in the past year and 12% less likely to report excellent health status than comparable seniors in the contiguous US.
  
  
  CONCLUSIONS
  Given the growth rate of Alaskan seniors and inherent health care challenges this vulnerable population faces, future research should examine the specific pathways through which these disparities occur and inform policies to ensure that all US seniors, regardless of geographical location, have access to high-quality health services.
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Foutz
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA; steven.cohen@vcuhealth.org.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Cohen
authors.affiliation: Center on Society and Health, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Cook
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D014481:United States
keywords: Alaska; health care; older adults