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.