Primary Care Associated with Improved Life Expectancy in Older US Adults: A Retrospective Cohort Study of National Survey Data

Background

Limited access to primary care may disproportionately affect older adults, who often have greater chronic disease management and care coordination needs. However, little is known about the effect of having a primary care practitioner (PCP) on longevity in the aging population.

Objective

To examine the association of having a usual source of primary care with mortality and life expectancy among US adults aged 65 and older.

Design

Retrospective cohort study, using nationally representative data from the 2000 and 2005 cohorts of the National Health Interview Survey linked with National Death Index records through 2019.

Participants

All respondents aged 65 to 84 (n = 10,873, weighted n = 16,484,914).

Interventions/Exposures

Having a usual source of primary care.

Main Measures

Using a Cox proportional hazards model, we examined the association between exposure to primary care and 15-year mortality, adjusting for sociodemographic factors and respondent life expectancy (using a validated index). We also used this model to generate survival curves by exposure to primary care and computed median survival times for each group.

Key Results

Overall, 60.3% of respondents were female, 83.6% were non-Hispanic White, and 6.4% (n = 739, weighted n = 1,056,554) did not have a usual source of primary care. Use of primary care was associated with a lower 15-year mortality risk (aHR: 0.84, 95% CI: 0.72–0.98). Median survival time was also at least 2.1 years longer among those who used primary care (> 15 years) compared to those who did not (12.9 years).

Conclusions

We found that primary care use is associated with greater survival among older adults. As the population of adults aged 65 + is growing rapidly, investing in primary care is essential for the health of US older adults.