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311497
Race disparities in “hotspots” of preventable hospitalizations in Maryland
Monday, November 17, 2014
Caryn Bell
,
Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are considered preventable. They serve as a proxy for a lack of access to primary care. Preventable hospitalizations (PHs) are more prevalent among African American patients, in urban cores and rural areas. However, few studies have empirically assessed the presence of geographic clusters of PHs, or “hotspots”. It is important to identify areas with high rates of PHs so that public health practitioners can efficiently target resources. Knowledge of PH hotspots allows researchers to characterize possible contextual and compositional effects on PHs. This study seeks to assess the presence of PH hotspots in the State of Maryland by race. Data for all hospitalizations in 2010 in Maryland were collected, including patient race/ethnicity, zip code of residence and primary diagnosis. Hospitalizations for ACSCs were considered preventable. The rate of PHs (per 100,000 population) for every zip code in Maryland was calculated. The spatial scan statistic was used to identify contiguous groups of zip codes with higher than average total, acute and chronic PH rates. The rate of total PHs in Maryland was 1,735.7 per 100,000. Among African Americans, the PH rate was 2,315.3 per 100,000. The PH rate among non-Hispanic whites was 1,724.6 per 100,000 (p<0.001). For the total population, there were ten hotspots. The largest included 27 zip codes with a radius of 30.5 kilometers. The PH rate for hotspots ranged from 5,022.4 per 100,000 (RR: 2.90, p<0.001) to 2,170.5 per 100,000 (RR: 1.25, p<0.001). There were four PH hotspots among African Americans with rates ranging from 4,142.2 per 100,000 (RR: 2.50, p<0.001) to 3,261.9 per 100,000 (RR: 1.40, p=0.015). The radius for the largest African American hotspots was 53.7 kilometers. There were nine hotspots among non-Hispanic whites. The PH rate in these hotspots ranged from 5,479.1 per 100,000 (RR: 3.01, p<0.001) to 2,290.6 per 100,000 (RR: 1.26, p<0.001). The largest hotspot had a radius of 15.7 kilometers. Public health practitioners can utilize this work to target resources and possibly develop culturally relevant interventions.
Learning Areas:
Chronic disease management and prevention
Diversity and culture
Epidemiology
Program planning
Public health or related public policy
Social and behavioral sciences
Learning Objectives:
Identify geographic clusters ("hotspots") of preventable hospitalizations (PHs)
Assess the effect of patient race/ethnicity on location of PH hotspots
Keyword(s): Data Collection and Surveillance, Minority Research
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I am a doctoral candidate whose research centers on the relationship between "place" and racial/ethnic health disparities in healthcare utilization and chronic disease management. A large part of my research focuses on spatial analysis methods for health disparities.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
