1

IssueBRIEF

Marisa Shenk, James Mabli, Arkadipta Ghosh, and Bob Schmitz, Mathematica

Older Americans Act Title III-C Nutrition 

Services Program: Examining the 

Diagnoses Underlying Adverse 

Health Events

BACKGROUND

Individuals typically face declining physical and cognitive function as they age. Older adults 

(ages 65 or older) experience hospitalizations at rates two to four times greater than prime-age 

adults (ages 18 to 64), and both hospitalization and readmission rates increase with age among 

Medicare beneficiaries age 65 and older (Gorina et al. 2015; McDermott et al. 2017). Many older 

adults live with chronic health conditions, including diabetes and heart disease, which can lead to 

complications and limitations in activities of daily living (AARP Chronic Care 2009). Additionally, 

more than 30 percent of individuals age 65 and older fall each year, and in half of the individuals, falls 

are recurrent (Dionyssiotis 2012). 

The underlying diagnoses associated with adverse health events among older adults vary widely, 

and include both chronic and acute conditions. Congestive heart failure, osteoarthritis, cardiac 

dysrhythmias, chronic obstructive pulmonary disease (COPD), pneumonia, and acute cerebrovascular 

disease are common diagnoses associated with hospitalizations (McDermott et al. 2017). Home-health 

patients were most frequently diagnosed with diabetes, congestive heart failure, COPD, hypertension, 

and cerebrovascular disease (Caffrey et al. 2011). About three-quarters of emergency department visits 

by older adults result from illness, with the remainder resulting from injury (Albert et al. 2017). 

The Older Americans Act Title III-C Nutrition Services Program (NSP) strives to promote the 

health and well-being of, and reduce hunger and food insecurity among, older adults by providing 

congregate and home-delivered meals. Overseen by the Administration on Aging (AoA) within the 

Administration for Community Living of the U.S. Department of Health and Human Services, the 

NSP is the largest program in the United States that provides prepared meals to older adults in need. 

It also provides a range of services, including nutrition education and counseling, opportunities for 

social engagement, and health promotion and disease prevention activities. 

The most recent evaluation of the effectiveness of the NSP on health outcomes found that the most 

prevalent adverse health events among congregate and home-delivered meal participants were hospital 

admissions, emergency department visits, and home health episodes (Mabli et al. 2018). The evaluation 

also found that the likelihood of experiencing an adverse health event was lower for nursing home 

admissions and similar for other events including home health episodes and emergency department 

visits for congregate meal participants compared to nonparticipants. The opposite was true for 

home-delivered meal participants, who were more likely than nonparticipants to experience hospital 

admissions, emergency department visits, and nursing home admissions. 

This issue brief examines the most common diagnoses underlying adverse health events experienced 

by NSP participants. Although research on the NSP has focused on the program’s effects on 

health and well-being, little is known about the diagnoses underlying adverse health events among 

participating older adults (Frongillo and Wolfe 2010; Mabli et al. 2017, 2018; Racine et al. 2012; June 2020

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1 Genitourinary symptoms consist 

of diseases, anomalies, trauma, or 

conditions of the genital organs 

or urinary structure.

Thomas et al. 2015, 2018; Wright et al. 2015). 

Understanding these diagnoses is particularly 

important for contextualizing the program effects 

presented in the most recent NSP evaluation 

(Mabli et al. 2018). For example, although NSP 

participants and nonparticipants differed in the 

likelihood of experiencing several types of adverse 

health events, it is unknown whether the severity 

of these events and the types of diagnoses differed 

among these two groups. Identifying these 

diagnoses can help program administrators tailor 

the health-promotion and disease-prevention 

services offered by many service providers in the 

Aging Network and can help providers more 

strongly integrate their programming with other 

community health partners.

METHODS

The data used in the analysis were collected as 

part of the Title III-C NSP Evaluation (Mabli et 

al. 2017, 2018). To estimate the effect of receiving 

a congregate or home-delivered meal on a range 

of outcomes, the study team compared outcomes 

for participants and a matched comparison group 

of program-eligible nonparticipants using data 

collected in surveys conducted in 2015 to 2017, 

as well as Medicare claims and enrollment data 

obtained through the Centers for Medicare 

& Medicaid Services (CMS) Research Data 

Assistance Center. The original evaluation sample 

consisted of 2,255 individuals. Restricting the 

sample to participants and nonparticipants with 

valid Medicare claims information resulted in the 

inclusion of 1,341 individuals in the analysis. 

This brief examines the diagnoses experienced 

by 676 participants and nonparticipants who 

had a hospitalization, emergency department 

visit, or home health episode over a 12-month 

period. These three types of events were the 

adverse health events participants were most 

likely to experience in the evaluation report 

(Mabli et al. 2018). Because individuals could 

experience multiple adverse health events 

during this period, each event is included as a 

separate observation. The diagnoses are based 

on ICD-10 Clinical Classification Software 

(CCS) primary diagnosis codes. The analysis 

only includes primary diagnoses associated with 

these events and experienced by at least 1 percent 

of program participants in the 9 months before 

the 12-month period. The primary or principal 

diagnosis on a Medicare claim identifies the 

condition that was mainly responsible for the 

patient’s visit to the hospital or health care 

provider, with additional diagnoses identified 

during treatment also listed on the claim.

Findings are analyzed separately for congregate 

and home-delivered meal participants and 

nonparticipants as well as for individuals living 

in lower-income or higher-income households. 

Individuals were defined as living in lowerincome households if their monthly income 

(calculated from the NSP outcomes survey 

as a percentage relative to the federal poverty 

threshold) was less than the median value in 

the sample (129 percent for congregate meal 

participants and 122 percent for home-delivered 

meal participants). Individuals living in higherincome households had monthly incomes greater 

than or equal to the median value.

FINDINGS

Most common diagnoses underlying 

events among congregate meal 

participants

The 10 most common primary diagnoses 

underlying adverse health events experienced by 

congregate meal participants account for more 

than two-thirds of these events (Table 1). The 

most frequent diagnosis was rheumatoid arthritis, 

osteoarthritis, or another connective tissue 

disorder (hereafter called arthritis) (12 percent). 

Other common diagnoses were diseases of the 

respiratory system, including COPD (10 percent), 

pneumonia (5 percent), or respiratory failure 

(4 percent); and diagnoses related to heart disease 

including nonspecific chest pain (9 percent) and 

cardiac dysrhythmias (6 percent). Urinary tract 

infection (UTI) (9 percent), superficial injuries 

(5 percent), fractures (4 percent), and diabetes 

(4 percent) were also common.

Most common diagnoses underlying 

events among home-delivered meal 

participants

Home-delivered meal participants experienced 

a wide array of diagnoses associated with their 

adverse health events. For this group, the top 

10 diagnoses cover about 60 percent of all events 

(Table 2). The most common diagnosis was arthritis 

(9 percent), followed by genitourinary symptoms 

(8 percent) and mood disorders (7 percent).1

Fractures and superficial injuries each represented 

6 percent of adverse health events, as did diabetes. 

Skin infections, hypertension, and COPD (each 

5 percent) and congestive heart failure (4 percent) 

were the next most common diagnoses.
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TABLE 1: Common primary diagnoses among congregate meal participants who 

experience adverse health events

Diagnosis Percentage

Rheumatoid arthritis, osteoarthritis, and other connective tissue diseases 11.67%

COPD 9.93%

Nonspecific chest pain 9.43%

UTI 9.06%

Cardiac dysrhythmias 5.53%

Superficial injury; contusion 4.73%

Pneumonia (except that caused by tuberculosis or sexually transmitted disease) 4.64%

Fractures 4.49%

Respiratory failure 4.47%

Diabetes 4.44%

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on an unweighted sample size of 294 events experienced by 117 congregate meal participants.

2

 Results for the full list of diagnoses 

prevalent among congregate meal 

participants are included in supplemental table 1.

3

 Results for the full list of diagnoses 

prevalent among home-delivered 

meal participants are included in 

supplemental table 2.

Differences in diagnoses between 

congregate meal participants and 

nonparticipants experiencing adverse 

health events

Although the share of congregate meal 

participants experiencing most types of adverse 

health events was either similar to or smaller 

than the share of nonparticipants experiencing 

these events (Mabli et al. 2018), the diagnoses 

associated with these events differ between 

these two groups. Compared to nonparticipants, 

congregate meal participants were more likely 

to have a diagnosis of nonspecific chest pain 

(7 percentage points), UTI (5 percentage 

points), or COPD or pneumonia (4 percentage 

points each) (Table 3). Conversely, participants 

were less likely than nonparticipants to have a 

primary diagnosis of fracture, open wounds, or 

arthritis (5 percentage points each).2

Some of these differences mainly reflect the 

experiences of lower-income individuals. 

Among lower-income households, participants 

were much less likely than nonparticipants to 

have a primary diagnosis of arthritis and were 

much more likely to be diagnosed with UTI 

or COPD. Among higher-income households, 

participants were less likely than nonparticipants 

to have hypertension but more likely to have 

conditions associated with dizziness or vertigo or 

a superficial injury.

Differences in diagnoses between 

home-delivered meal participants and 

nonparticipants experiencing adverse 

health events

There are large differences in the types of 

diagnoses for adverse health events experienced 

by home-delivered meal participants compared 

to nonparticipants. Participants were more likely 

than nonparticipants to have primary diagnoses 

of genitourinary symptoms (8 percentage 

points), mood disorders (6 percentage points), 

skin infections (5 percentage points), or 

chronic skin ulcers or pneumonia (3 percentage 

points each); these diagnoses were all very 

uncommon among nonparticipants (Table 4). 

Participants were less likely to be diagnosed with 

hypertension (9 percentage points), diabetes 

(6 percentage points), nonspecific chest pain 

(5 percentage points), or cardiac dysrhythmias 

or COPD (3 percentage points each).3
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TABLE 2: Common primary diagnoses among home-delivered meal participants 

who experience adverse health events

Diagnosis Percentage

Rheumatoid arthritis, osteoarthritis, and other connective tissue diseases 8.61%

Genitourinary symptoms and ill-defined conditions 8.17%

Mood disorders 7.17%

Fractures 6.45%

Diabetes 6.05%

Superficial injury; contusion 5.55%

Skin and subcutaneous tissue infections 5.31%

Hypertension 5.02%

COPD 4.90%

Congestive heart failure 4.30%

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on an unweighted sample size of 506 events experienced by 167 home-delivered meal participants.

TABLE 3: Differences in the prevalence of diagnoses underlying adverse events 

experienced by congregate meal participants and nonparticipants

Diagnosis

Percentage

Participants Nonparticipants Difference

Largest positive differences

Nonspecific chest pain 9.4% 2.0% 7.4

UTI 9.1% 3.6% 5.4

COPD 9.9% 5.7% 4.2

Pneumonia (except that caused by tuberculosis or 

sexually transmitted disease) 4.6% 0.9% 3.7

Diabetes 4.4% 1.6% 2.8

Largest negative differences

Other diseases of veins and lymphatics 0.4% 2.8% -2.4

Hypertension 3.4% 5.8% -2.4

Rheumatoid arthritis, osteoarthritis, and other 

connective tissue diseases 11.7% 16.6% -5.0

Open wounds of extremities 1.6% 6.9% -5.4

Fracture 4.5% 9.9% -5.4

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on unweighted sample sizes of 302 congregate meal participants and nonparticipants.
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TABLE 4: Differences in the most prevalent diagnoses underlying adverse events 

experienced by home-delivered meal participants and nonparticipants

Diagnosis

Percentage

Participants Nonparticipants Difference

Largest positive differences

Genitourinary symptoms and ill-defined conditions 8.2% 0.3% 7.9

Mood disorders 7.2% 0.8% 6.3

Skin and subcutaneous tissue infections 5.3% 0.0% 5.3

Chronic ulcer of skin 3.4% 0.0% 3.4

Pneumonia (except that caused by tuberculosis or 

sexually transmitted disease) 4.3% 1.5% 2.8

Largest negative differences

COPD 4.9 7.6 -2.7

Cardiac dysrhythmias 2.4 5.6 -3.2

Nonspecific chest pain 2.4 7.6 -5.3

Diabetes 6.0 12.0 -6.0

Hypertension 5.0 13.6 -8.6

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on unweighted sample sizes of 374 home-delivered meal participants and nonparticipants.

Most of these differences reflect the experiences 

of lower-income individuals. Among lowerincome households, home-delivered meal 

participants were less likely than nonparticipants 

to be diagnosed with hypertension, diabetes, 

or cardiac dysrhythmias. Participants were 

more likely to have a primary diagnosis of 

genitourinary symptoms or mood disorders 

and to have a diagnosis of chronic skin ulcer. 

Participants in higher-income households 

generally had fewer large differences in types 

of diagnoses compared to nonparticipants; 

for example, participants and nonparticipants 

reported similar rates of genitourinary 

symptoms and mood disorders. There were a few 

exceptions; for example, among higher-income 

households, participants were more likely than 

nonparticipants to be diagnosed with skin 

infections and less likely to be diagnosed with 

nonspecific chest pain. 

DISCUSSION

This brief identified the most common 

diagnoses for NSP participants experiencing 

adverse health events. Arthritis was the most 

frequent diagnosis for both congregate meal 

and home-delivered meal participants. Among 

congregate meal participants, other common 

diagnoses were respiratory diseases like COPD, 

chest pain, UTIs, dysrhythmias, and injuries. 

For home-delivered meal participants, the most 

common diagnoses after arthritis span a wide 

array of conditions including genitourinary 

symptoms, mood disorders, fractures, diabetes, 

injuries, and infections. Program administrators 

could consider incorporating health-promotion 

and disease-prevention activities related to 

common diagnoses into their programming to 

help participants manage their health conditions 

and mitigate risks involved with experiencing 

adverse health events.
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The information presented in this brief 

complements the findings in a recent evaluation 

examining health care utilization by NSP 

participation. The evaluation found that 

congregate meal participants and nonparticipants 

had similar likelihood of experiencing an adverse 

health event such as a hospitalization, home 

health episode, or emergency department visit 

(Mabli et al. 2018). Although participants were 

not more or less likely than nonparticipants to 

experience these types of events, the types of 

diagnoses associated with these adverse health 

events differed between groups. Considering 

that congregate meal participants were more 

likely than nonparticipants to be diagnosed with 

nonspecific chest pain, UTIs, and respiratory 

diseases, health promotion activities provided 

by local sites should be assessed to ensure that 

participants receive information relevant to these 

diagnoses. At the same time, participants were less 

likely than nonparticipants to be diagnosed with 

arthritis, fractures, and open wounds, possibly 

reflecting the effectiveness of congregate meal 

sites’ programming around falls prevention, or 

reflecting differences between participants and 

nonparticipants in their access to preventive care 

including fall prevention guidance. Learning more 

about whether NSP-eligible nonparticipants 

are aware of health promotion services offered 

through the NSP may improve program outreach 

and targeting and help to reduce the risk of 

fractures, wounds, and other consequences of falls. 

The evaluation report found that home-delivered 

meal participants were more likely than 

nonparticipants to experience hospitalizations 

and emergency department visits (Mabli et 

al. 2018). These participants were also more 

likely than nonparticipants to be diagnosed 

with genitourinary symptoms, mood disorders, 

and skin infections and skin ulcers. Some of 

these types of diagnoses may be associated with 

lower mobility among homebound older adults. 

According to the evaluation report, more than 

9 percent of home-delivered meal participants 

were chair bound, and about 2 percent were 

bed bound (Mabli et al. 2017). Infections and 

other acute primary diagnoses like pneumonia 

may be induced or exacerbated by secondary 

diagnoses, chronic conditions, and other illnesses 

or injuries that led participants to be homebound 

in the first place. AoA might consider offering 

NSP provider staff and meal delivery drivers 

additional education and training regarding how 

to effectively recognize signs of these diagnoses 

to help participants manage their health needs, 

or consider examining what health promotion 

services tailored to this population are available 

for dissemination. Participants were less likely 

than nonparticipants to be diagnosed with 

diabetes, hypertension, and nonspecific chest pain. 

Eligible nonparticipants could also benefit from 

targeted outreach and information about health 

services related to these diagnoses that the NSP 

provides as well as information about specialized 

meal deliveries. For example, the evaluation report 

found that about one in three home-delivered 

meal participants was on a special diet, and 

about 60 percent of those participants were on 

diabetic diets (Mabli et al. 2017). Promoting 

the availability of these types of specialized 

meal offerings to individuals currently not 

participating in the NSP may attract new older 

adults to the program and, in turn, help program 

administrators fulfill their mission of providing 

healthy meals and services to older adults in need. 
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REFERENCES

AARP Chronic Care. “A Call to Action for 

Health Reform.” Washington, DC: AARP, 2009. 

Available at http://assets.aarp.org/rgcenter/health/

beyond_50_hcr.pdf. Accessed June 5, 2019.

Albert, Michael, Pinyao Rui, and Linda F. McCaig. 

“Emergency Department Visits for Injury and 

Illness Among Adults Aged 65 and Over: United 

States, 2012–2013.” NCHS Data Brief, no 272. 

Hyattsville, MD: National Center for Health 

Statistics, February 2017.

Caffrey, Christine, Manisha Sengupta, Abigail 

Moss, Lauren Harris-Kojetin, and Roberto 

Valverde. “Home Health Care and Discharged 

Hospice Care Patients: United States, 2000 and 

2007.” National Health Statistics Reports, no 

38. Hyattsville, MD: National Center for Health 

Statistics, April 27, 2011.

Dionyssiotis, Yannis. “Analyzing the Problem of 

Falls Among Older People.” International Journal of 

General Medicine, vol. 5, 2012, pp. 805–813. 

Frongillo, Edward A., and Wendy S. Wolfe. 

“Impact of Participation in Home-Delivered Meals 

on Nutrient Intake, Dietary Patterns, and Food 

Insecurity of Older Persons in New York State.” 

Journal of Nutrition for the Elderly, vol. 29, no. 3, 

2010, pp. 293–310.

Gorina, Yelena, Laura A. Pratt, Ellen A. Kramarow, 

and Nazik Elgaddal. “Hospitalization, Readmission, 

and Death Experience of Noninstitutionalized 

Medicare Fee-for-Service Beneficiaries Aged 65 

and Over.” National Health Statistics Reports, no 

84. Hyattsville, MD: National Center for Health 

Statistics, September 28, 2015.

Mabli, James, Arkadipta Ghosh, Bob Schmitz, 

Marisa Shenk, Erin Panzarella, Barbara Carlson, 

and Mark Flick. “Evaluation of the Effect of 

the Older Americans Act Title III-C Nutrition 

Services Program on Participants’ Health Care 

Utilization.” Washington, DC: U.S. Department 

of Health and Human Services, Administration 

for Community Living, September 14, 2018. 

Available at https://acl.gov/sites/default/

files/programs/2018-10/NSPevaluation_

healthcareutilization.pdf. Accessed April 22, 2019.

Mabli, James, Elizabeth Gearan, Rhoda Cohen, 

Katherine Niland, Nicholas Redel, Erin Panzarella, 

and Barbara Carlson. “Evaluation of the Effect of 

the Older Americans Act Title III-C Nutrition 

Services Program on Participants’ Food Security, 

Socialization, and Diet Quality.” Washington, DC: 

U.S. Department of Health and Human Services, 

Administration for Community Living, April 21, 

2017. Available at https://www.mathematica-mpr.

com/our-publications-and-findings/publications/

evaluation-of-the-effect-of-the-older-americansact-title-iii-c-nutrition-services-program. 

Accessed January 23, 2018.

McDermott, Kimberly, Anne Elixhauser, and 

Ruirui Sun. “Trends in Hospital Inpatient Stays in 

the United States, 2005–2014.” HCUP Statistical 

Brief #225. Rockville, MD: Agency for Healthcare 

Research and Quality, June 2017. Available at 

https://www.hcup-us.ahrq.gov/reports/statbriefs/

sb225-Inpatient-US-Stays-Trends.pdf. Accessed 

September 30, 2019.

Racine, Elizabeth F., Jordan Lyerly, Jennifer L. 

Troyer, Jan Warren-Findlow, and William J. 

McAuley. “The Influence of Home-Delivered 

Dietary Approaches to Stop Hypertension Meals 

on Body Mass Index, Energy Intake, and Percent 

of Energy Needs Consumed Among Older Adults 

with Hypertension and/or Hyperlipidemia.” 

Journal of the Academy of Nutrition and Dietetics, vol. 

112, no. 11, 2012, pp. 1755–1762.

Thomas, Kali S., Emily A. Gadbois, Renee 

R. Shield, Ucheoma Akobundu, Andrea M. 

Morris, and David M. Dosa. “‘It’s Not Just a 

Simple Meal. It’s So Much More’: Interactions 

Between Meals on Wheels Clients and Drivers.” 

Journal of Applied Gerontology, 2018. https://doi.

org/10.1177/0733464818820226

Thomas, Kali S., Ucheoma Akobundu, and David 

Dosa. “More Than a Meal? A Randomized Control 

Trial Comparing the Effects of Home-Delivered 

Meals Programs on Participants’ Feelings of 

Loneliness.” Journals of Gerontology Series B: 

Psychological Sciences and Social Sciences, vol. 71, no. 

6, 2015, pp. 1049–1058.

Wright, Lauri, Lauren Vance, Christina Sudduth, 

and James B. Epps. “The Impact of a HomeDelivered Meal Program on Nutritional Risk, 

Dietary Intake, Food Security, Loneliness, and Social 

Well-Being.” Journal of Nutrition in Gerontology and 

Geriatrics, vol. 34, no. 2, 2015, pp. 218–227.
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SUPPLEMENTAL TABLE 1: Differences in the prevalence of diagnoses underlying 

adverse events experienced by congregate meal participants and nonparticipants

Diagnosis

Percentage

Participants Nonparticipants Difference

Largest positive differences

Nonspecific chest pain 9.4% 2.0% 7.4

UTI 9.1% 3.6% 5.4

COPD 9.9% 5.7% 4.2

Pneumonia (except that caused by tuberculosis or sexually 

transmitted disease) 4.6% 0.9% 3.7

Diabetes 4.4% 1.6% 2.8

Superficial injury; contusion 4.7% 2.3% 2.4

Conditions associated with dizziness or vertigo 3.9% 1.6% 2.3

Other aftercare 3.3% 1.0% 2.2

Congestive heart failure 3.4% 1.8% 1.6

Respiratory failure 4.5% 2.9% 1.5

Other nervous system disorders 2.1% 1.1% 0.9

Other liver diseases 0.0% 0.0% 0.0

Skin and subcutaneous tissue infections 1.9% 1.9% -0.1

Other upper respiratory infections 0.7% 1.0% -0.4

Other gastrointestinal disorders 3.2% 3.7% -0.6

Genitourinary symptoms and ill-defined conditions 0.9% 1.6% -0.7

Cardiac dysrhythmias 5.5% 6.3% -0.8

Other injuries and conditions due to external causes 3.0% 4.0% -1.0

Syncope 0.2% 1.2% -1.1

Open wounds of head, neck, and trunk 0.6% 1.9% -1.3

Sprains and strains 0.7% 2.1% -1.3

Acute myocardial infarction 0.7% 2.2% -1.6

Complications of surgical procedures or medical care 0.0% 1.6% -1.6

Abdominal pain 1.7% 3.7% -1.9

Acute and unspecified renal failure 0.1% 2.0% -1.9

Other diseases of veins and lymphatics 0.4% 2.8% -2.4

Hypertension 3.4% 5.8% -2.4

Rheumatoid arthritis, osteoarthritis, and other connective 

tissue diseases 11.7% 16.6% -5.0

Open wounds of extremities 1.6% 6.9% -5.4

Fracture 4.5% 9.9% -5.4

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on unweighted sample sizes of 302 congregate meal participants and nonparticipants.
9

SUPPLEMENTAL TABLE 2: Differences in the most prevalent diagnoses underlying 

adverse events experienced by home-delivered meal participants and nonparticipants

Diagnosis

Percentage

Participants Nonparticipants Difference

Largest positive differences

Genitourinary symptoms and ill-defined conditions 8.2% 0.3% 7.9

Mood disorders 7.2% 0.8% 6.3

Skin and subcutaneous tissue infections 5.3% 0.0% 5.3

Chronic ulcer of skin 3.4% 0.0% 3.4

Pneumonia (except that caused by tuberculosis or sexually 

transmitted disease) 4.3% 1.5% 2.8

Superficial injury; contusion 5.5% 3.4% 2.2

Neoplasms of unspecified nature or uncertain behavior 1.6% 0.0% 1.6

Delirium, dementia, and amnestic and other cognitive disorders 1.3% 0.3% 1.1

Other nervous system disorders 2.8% 1.9% 0.9

Deficiency and other anemia 1.6% 0.7% 0.9

Late effects of cerebrovascular disease 1.7% 0.9% 0.9

Fracture 6.5% 6.0% 0.4

Other aftercare 2.1% 2.0% 0.1

Urinary tract infections 3.6% 3.6% 0.0

Rehabilitation care; fitting of prostheses; and adjustment of devices 0.0% 0.0% 0.0

Alcohol-related disorders 0.0% 0.0% 0.0

Other upper respiratory infections 1.1% 1.2% -0.1

Other gastrointestinal disorders 2.4% 2.6% -0.2

Pulmonary heart disease 0.1% 0.4% -0.2

Sprains and strains 2.6% 3.0% -0.3

Malaise and fatigue 0.9% 1.3% -0.4

Congestive heart failure 4.3% 5.1% -0.8

Other injuries and conditions due to external causes 0.4% 1.7% -1.3

Rheumatoid arthritis, osteoarthritis, and other connective tissue 

diseases 8.6% 10.9% -2.3

Abdominal pain 2.6% 5.1% -2.4

COPD 4.9% 7.6% -2.7

Cardiac dysrhythmias 2.4% 5.6% -3.2

Nonspecific chest pain 2.4% 7.6% -5.3

Diabetes 6.0% 12.0% -6.0

Hypertension 5.0% 13.6% -8.6

Source: Medicare claims and enrollment data matched to AoA NSP outcomes survey, 2015–2016, weighted data. 

Note: The most common diagnoses reported for individuals who experienced a hospitalization, emergency department visit, or home health episode in the 

12-month observation period. Tabulations are based on unweighted sample sizes of 374 home-delivered meal participants and nonparticipants.