Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries

作者：Jay B. Lusk, Molly N. Hoffman, Amy G. Clark, Hannah Mahoney, Beau Blass, Jonathan Bae, Deepshikha Charan Ashana, Christopher E. Cox, Bradley G. Hammill · 发表于：Annals of the American Thoracic Society · 年份：2023 · DOI：10.1513/annalsats.202304-310oc · 被引用次数：15 · 研究领域：Health disparities and outcomes、Healthcare Policy and Management、Food Security and Health in Diverse Populations

Abstract Rationale Understanding how systemic forces and environmental exposures impact patient outcomes is critical to advancing health equity and improving population health for patients with pulmonary disease. This relationship has not yet been assessed at the population level nationally. Objectives To determine whether neighborhood socioeconomic deprivation is independently associated with 30-day mortality and readmission for hospitalized patients with pulmonary conditions, after controlling for demographics, access to healthcare resources, and characteristics of admitting healthcare facilities. Methods This was a retrospective, population-level cohort study of 100% of United States nationwide Medicare inpatient and outpatient claims from 2016–2019. Patients were admitted for one of four pulmonary conditions (pulmonary infections, chronic lower respiratory disease, pulmonary embolism, and pleural and interstitial lung diseases), defined by diagnosis-related group. The primary exposure was neighborhood socioeconomic deprivation, measured by the area deprivation index. The main outcomes were 30-day mortality and 30-day unplanned readmission, defined by Centers for Medicare and Medicaid Services methodologies. Generalized estimating equations were used to estimate logistic regression models for the primary outcomes, addressing clustering by hospital. A sequential adjustment strategy was first adjusted for age, legal sex, Medicare–Medicaid dual eligibility, and comorbidity bu...