Social Network Density and Healthcare Access and Utilization Among Racially and Ethnically Diverse Older Adults

Previous literature emphasizes the benefits of social integration for accessing and utilizing healthcare. However, many studies overlook the role of social network infrastructure, specifically the degree to which a network is interconnected (social network density). Social network density has been associated physiological benefits for ethnic minority older adults; however, little is known about whether a densely connected social network facilitates healthcare access and utilization. The current study examined the association between social network density, healthcare access, and utilization across racial and ethnic groups over five years in a national sample of older adults.

Waves 1 (2005-2006) and 2 (2010-2011) from The National Social Life, Health, and Aging Project (N=2240) were analyzed. Social network data were collected using ego-centric network rosters and analyzed using social network analysis. We estimated multiple logistic regression models weighted for selection probability and nonresponse with binary healthcare access and utilization outcomes. Each model included the interaction between social network density and racial-ethnic group, their main effects, and relevant covariates.

Racial-ethnic group significantly moderated associations between social network density and healthcare access (Wald χ2 (4, 1641)=4.41, P=0.002) and utilization (Wald χ2 (4, 1642)=2.84, P=0.023). Social network density only benefited non-Hispanic White older adults and was, conversely, risky for American Indian/Alaska Native older adults. Other between-group differences were observed.

Our study did not find that social network density was protective for healthcare access and utilization. Our findings reveal the complex interaction among network dynamics, U.S. racial-ethnic status, and health behavior.