Measuring Local-Area Racial Segregation for Medicare Hospital Admissions.
JAMA Netw Open
; 7(4): e247473, 2024 Apr 01.
Article
en En
| MEDLINE
| ID: mdl-38639935
ABSTRACT
Importance Considerable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited. Objective:
To measure how and where sorting of older Black patients to different hospitals occurs within the same health care market. Design, Setting, andParticipants:
This retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital's admissions and the racial composition of the hospital's market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024. Exposure Degree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status. Main Outcomes andMeasures:
The LHS index by hospital and a regional LHS index by hospital referral region.Results:
In the sample of 1991 acute care hospitals, 4â¯870â¯252 patients (mean [SD] age, 77.7 [8.3] years; 2â¯822â¯006 [56.0%] female) were treated, including 11â¯435 American Indian or Alaska Native patients (0.2%), 129â¯376 Asian patients (2.6%), 597â¯564 Black patients (11.9%), 395â¯397 Hispanic patients (7.8), and 3â¯818â¯371 White patients (75.8%). In the sample, half of hospitalizations among Black patients occurred at 235 hospitals (11.8% of all hospitals); 878 hospitals (34.4%) exhibited a negative LHS score (ie, admitted fewer Black patients relative to their market area) while 1113 hospitals (45.0%) exhibited a positive LHS (ie, admitted more Black patients relative to their market area); of all hospitals, 79.4% exhibited racial admission patterns significantly different from their market. Hospital-level LHS was positively associated with government hospital status (coefficient, 0.24; 95% CI, 0.10 to 0.38), while New York, New York; Chicago, Illinois; and Detroit, Michigan, hospital referral regions exhibited the highest regional LHS measures, with hospital referral region LHS scores of 0.12, 0.16, and 0.21, respectively. Conclusions and Relevance In this cross-sectional study, a novel measure of LHS was developed to quantify the extent to which hospitals were admitting a representative proportion of Black patients relative to their market areas. A better understanding of hospital choice within neighborhoods would help to reduce racial inequities in health outcomes.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Medicare
/
Segregación Social
Límite:
Aged
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Año:
2024
Tipo del documento:
Article