Hospital characteristics by proportion of patients from disadvantaged neighborhoods

Abstract

Neighborhood disadvantage reflects historic and ongoing systemic injustices.Without addressing these upstream social determinants of health, hospitals may face different risk profiles for important quality metrics. Our objective was to assess differences in hospital characteristics where the proportion of patients residing in severely disadvantaged neighborhoods was high versus low. Using Medicare feefor-service claims between January 1, 2014 and November 30, 2014 (5,807,499 hospital stays), we calculated area disadvantage share (ADS), the proportion of each hospital's discharges to severely disadvantaged neighborhoods, for 4528 hospitals.We examined hospital characteristics by a distribution of ADS and by risk-adjusted 30-day readmission. Hospitals in the highest decile cared for a higher proportion of Black patients, were more often located in rural areas, and had a higher patient risk of 30-day readmission compared with all other deciles. Hospitals face unequal burdens of neighborhood disadvantage, a factor distinct from other social determinants such as rurality.

Transportation Justice and Health

“…Health system leaders may be motivated to incorporate innovative approaches to addressing transportation needs as evidence in policy changes supporting screening and addressing social risk, and health services research increasingly demonstrate the associations among unmet social needs, worse health outcomes, and higher utilization of emergency department and hospitalization services. [27][28][29]…”

“…Inevitably, the transformative work of transportation justice will require researchers and policymakers to break out of traditional silos to address the interconnected patterns of injustice that have led to the unfair distribution of transportation and other social determinants of health. Health system leaders may be motivated to incorporate innovative approaches to addressing transportation needs as evidence in policy changes supporting screening and addressing social risk, and health services research increasingly demonstrate the associations among unmet social needs, worse health outcomes, and higher utilization of emergency department and hospitalization services 27–29 …”