Health-related quality of life among adults 65 years and older in the United States, 2011-2012: a multilevel small area estimation approach.
The purpose of this study was to develop county-level estimates of poor health-related quality of life (HRQOL) among aged 65 years and older U.S. adults and to identify spatial clusters of poor HRQOL using a multilevel, poststratification approach.



Multilevel, random-intercept models were fit to HRQOL data (two domains: physical health and mental health) from the 2011-2012 Behavioral Risk Factor Surveillance System. Using a poststratification, small area estimation approach, we generated county-level probabilities of having poor HRQOL for each domain in U.S. adults aged 65 and older, and validated our model-based estimates against state and county direct estimates.



County-level estimates of poor HRQOL in the United States ranged from 18.07% to 44.81% for physical health and 14.77% to 37.86% for mental health. Correlations between model-based and direct estimates were higher for physical than mental HRQOL. Counties located in the Arkansas, Kentucky, and Mississippi exhibited the worst physical HRQOL scores, but this pattern did not hold for mental HRQOL, which had the highest probability of mentally unhealthy days in Illinois, Indiana, and Vermont.



Substantial geographic variation in physical and mental HRQOL scores exists among older U.S. adults. State and local policy makers should consider these local conditions in targeting interventions and policies to counties with high levels of poor HRQOL scores.
National Institute of Environmental Health Research Center, National Health Research Institutes, Taiwan.
Yu-Hsiu
YH
Lin
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
Alexander C
AC
McLain
Department of Health Services Policy & Management, University of South Carolina, Columbia; South Carolina Rural Health Research Center, University of South Carolina, Columbia.
Janice C
JC
Probst
South Carolina Rural Health Research Center, University of South Carolina, Columbia; Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia.
Kevin J
KJ
Bennett
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
Zaina P
ZP
Qureshi
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; South Carolina Rural Health Research Center, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia. Electronic address: jmeberth@mailbox.sc.edu.
Jan M
JM
Eberth
D000368:Aged; D000369:Aged, 80 and over; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D015438:Health Behavior / Q000208:ethnology; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D011788:Quality of Life; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D017062:Small-Area Analysis; D014481:United States
Health-related quality of life; Multilevel; Older adults; Poststratification; Small area estimation