Amy J.H. Kind, MD, PhD; Steve Jencks, MD, MPH; Jane Brock, MD, MSPH; Menggang Yu, PhD; Christie Bartels, MD; William Ehlenbach, MD, Msc; Caprice Greenberg, MD; Maureen Smith, MD, MPH, PhD
Disclaimer: The contents of this article do not reflect Centers for Medicare & Medicaid Services policy.
Acknowledgment: The authors thank Peggy Munson for Institutional Review Board assistance; Katie Ronk for data management assistance; Bill Buckingham for map creation; and Brock Polnaszek, Jacquelyn Porter, Melissa Hovanes, and Colleen Brown for help with manuscript formatting.
Grant Support: By the National Institute on Aging (Paul D. Beeson Career Development Award [K23AG034551]), the American Federation for Aging Research, the John A. Hartford Foundation, The Atlantic Philanthropies, and The Starr Foundation. Dr. Kind's time was also partially supported by the University of Wisconsin School of Medicine and Public Health from the Wisconsin Partnership Program. Additional support was provided by the University of Wisconsin School of Medicine and Public Health's Health Innovation Program, the Community–Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research, and the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (grant 1UL1RR025011). Dr. Brock's time was partially supported by the Integrating Care for Populations & Communities National Coordinating Center at Colorado Foundation for Medical Care, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2946.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Kind (email, firstname.lastname@example.org).
Requests for Single Reprints: Amy J.H. Kind, MD, PhD, Geriatric Research Education and Clinical Center, William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705; e-mail, email@example.com.
Current Author Addresses: Dr. Kind: Geriatric Research Education and Clinical Center, William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705.
Dr. Jencks: 8 Midvale Road, Baltimore, MD 21210.
Dr. Brock: Telligen, Colorado Foundation for Medical Care, 23 Inverness Way East, Suite 100, Englewood, CO 80112.
Dr. Yu: University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705.
Dr. Bartels: University of Wisconsin School of Medicine and Public Health, Rheumatology, Room 4132, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI 53705.
Dr. Ehlenbach: University of Wisconsin School of Medicine and Public Health, Room 5245 Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI 53705.
Dr. Greenberg: University of Wisconsin School of Medicine and Public Health, BX7375 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792.
Dr. Smith: University of Wisconsin School of Medicine and Public Health, Room 210-31, 800 University Bay Drive, Madison, WI 53705.
Author Contributions:Conception and design: A.J.H. Kind, S. Jencks, J. Brock, C. Greenberg, M. Smith.
Analysis and interpretation of the data: A.J.H. Kind, S. Jencks, J. Brock, M. Yu, C. Bartels, W. Ehlenbach, C. Greenberg, M. Smith.
Drafting of the article: A.J.H. Kind, S. Jencks, J. Brock.
Critical revision of the article for important intellectual content: A.J.H. Kind, S. Jencks, J. Brock, M. Yu, C. Bartels, W. Ehlenbach, C. Greenberg, M. Smith.
Final approval of the article: A.J.H. Kind, S. Jencks, J. Brock, C. Bartels, C. Greenberg, M. Smith.
Statistical expertise: A.J.H. Kind, M. Yu.
Obtaining of funding: A.J.H. Kind, M. Smith.
Administrative, technical, or logistic support: A.J.H. Kind, M. Smith.
Collection and assembly of data: A.J.H. Kind, C. Greenberg, M. Smith.
Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of U.S. neighborhood socioeconomic disadvantage are more readily available but are rarely used clinically.
To evaluate the association between neighborhood socioeconomic disadvantage at the census block group level, as measured by the Singh validated area deprivation index (ADI), and 30-day rehospitalization.
Retrospective cohort study.
Random 5% national sample of Medicare patients discharged with congestive heart failure, pneumonia, or myocardial infarction between 2004 and 2009 (n = 255 744).
Medicare data were linked to 2000 census data to construct an ADI for each patient's census block group, which were then sorted into percentiles by increasing ADI. Relationships between neighborhood ADI grouping and 30-day rehospitalization were evaluated using multivariate logistic regression models, controlling for patient sociodemographic characteristics, comorbid conditions and severity, and index hospital characteristics.
The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI. This relationship persisted after full adjustment, with the most disadvantaged neighborhoods having a rehospitalization risk (adjusted risk ratio, 1.09 [95% CI, 1.05 to 1.12]) similar to that of chronic pulmonary disease (adjusted risk ratio, 1.06 [CI, 1.04 to 1.08]) and greater than that of uncomplicated diabetes (adjusted risk ratio, 0.95 [CI, 0.94 to 0.97]).
No direct markers of care quality or access.
Residence within a disadvantaged U.S. neighborhood is a rehospitalization predictor of magnitude similar to chronic pulmonary disease. Measures of neighborhood disadvantage, such as the ADI, could potentially be used to inform policy and care after hospital discharge.
National Institute on Aging and University of Wisconsin School of Medicine and Public Health's Institute for Clinical and Translational Research and Health Innovation Program.
Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, et al. Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study. Ann Intern Med. ;161:765–774. doi: 10.7326/M13-2946
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Published: Ann Intern Med. 2014;161(11):765-774.
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