Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia
复制标题
DOI：
10.1007/s11606-021-07090-z
复制
发表时间：
2021-09-10
影响因子：
5.7
通讯作者：
Wadhera, Rishi K.
中科院分区：
文献类型：
--
作者：
Hermes, Zachary;Maddox, Karen E. Joynt;Wadhera, Rishi K.
背景技术背景：医疗保险和医疗补助服务中心的医院基于价值的采购计划使用急性心肌梗死、心力衰竭和肺炎的30天死亡率来评估美国医院，但在比较它们的表现时没有考虑社区的社会经济劣势。目的：为了确定邻里社会经济劣势是否与30岁以下的人更差有关，在美国，以及在黑人人口比例高的县的子集内，急性心肌梗死（AMI）、心力衰竭（HF）或肺炎住院后的日死亡率。这项基于人群的回顾性研究包括2012年至2015年期间因急性心肌梗死、心力衰竭或肺炎住院的所有65岁或以上的Medicare按服务收费受益人。居住在社会经济条件最差的社区与居住在社会经济条件不太差的社区，以地区贫困指数衡量。入院后30天内的全因死亡率。关键结果：该研究包括3，471，592名医疗保险患者。在这些患者中，333，472人居住在最贫困的社区，3，138，120人居住在不太贫困的社区。生活在最弱势社区的患者更年轻（78.4岁对80.0岁），更有可能是黑人成年人（24.6%对7.5%）和双重参加医疗补助（39.4%对21.8%）。在调整人口统计学（年龄、性别、种族/民族）、贫困和临床合并症后，居住在最弱势社区的受益人中，AMI（调整后的比值比1.08，95% CI 1.06-1.11）和肺炎（aOR 1.05，1.03-1.07）的30天死亡率较高，但HF（aOR 1.02，1.00-1.04）的30天死亡率不高。这些模式在黑人成年人比例较高的美国县的子集中是相似的（AMI，aOR 1.07，1.03-1.11; HF 1.02，0.99-1.05;肺炎1.03，1.00-1.07）。社区社会经济劣势与基于价值的计划针对的某些条件的30天死亡率较高相关，即使在考虑了个体水平的人口统计学、临床合并症和贫困之后。这些发现可能会影响决策者权衡战略，以促进健康公平下基于价值的计划。
BACKGROUND: The Centers for Medicare and Medicaid Services' Hospital Value-Based Purchasing program uses 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia to evaluate US hospitals, but does not account for neighborhood socioeconomic disadvantage when comparing their performance.OBJECTIVE: To determine if neighborhood socioeconomic disadvantage is associated with worse 30-day mortality rates after a hospitalization for acute myocardial infarction (AMI), heart failure (HF), or pneumonia in the USA, as well as within the subset of counties with a high proportion of Black individuals.DESIGN AND PARTICIPANTS: This retrospective, population-based study included all Medicare fee-for-service beneficiaries aged 65 years or older hospitalized for acute myocardial infarction, heart failure, or pneumonia between 2012 and 2015.EXPOSURE: Residence in most socioeconomically disadvantaged vs. less socioeconomically disadvantaged neighborhoods as measured by the area deprivation index (ADI).MAIN MEASURE(S): All-cause mortality within 30 days of admission.KEY RESULTS: The study included 3,471,592 Medicare patients. Of these patients, 333,472 resided in most disadvantaged neighborhoods and 3,138,120 in less disadvantaged neighborhoods. Patients living in the most disadvantaged neighborhoods were younger (78.4 vs. 80.0 years) and more likely to be Black adults (24.6% vs. 7.5%) and dually enrolled in Medicaid (39.4% vs. 21.8%). After adjustment for demographics (age, sex, race/ethnicity), poverty, and clinical comorbiditles, 30-day mortality was higher among beneficiaries residing in most disadvantaged neighborhoods for AMI (adjusted odds ratio 1.08, 95% CI 1.06-1.11) and pneumonia (aOR 1.05, 1.03-1.07), but not for HF (aOR 1.02, 1.00-1.04). These patterns were similar within the subset of US counties with a high proportion of Black adults (AMI, aOR 1.07, 1.03-1.11; HF 1.02, 0.99-1.05; pneumonia 1.03, 1.00-1.07).CONCLUSIONS: Neighborhood socioeconomic disadvantage is associated with higher 30-day mortality for some conditions targeted by value-based programs, even after accounting for individual-level demographics, clinical comorbidities, and poverty. These findings may have implications as policymakers weigh strategies to advance health equity under value-based programs.