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, 161 (11), 765-74

Neighborhood Socioeconomic Disadvantage and 30-day Rehospitalization: A Retrospective Cohort Study

Neighborhood Socioeconomic Disadvantage and 30-day Rehospitalization: A Retrospective Cohort Study

Amy J H Kind et al. Ann Intern Med.


Background: 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.

Objective: 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.

Design: Retrospective cohort study.

Setting: United States.

Patients: Random 5% national sample of Medicare patients discharged with congestive heart failure, pneumonia, or myocardial infarction between 2004 and 2009 (n = 255,744).

Measurements: 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.

Results: 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]).

Limitation: No direct markers of care quality or access.

Conclusion: 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.

Primary funding source: 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.

Conflict of interest statement

Conflict of Interest Disclosure: No other disclosures are reported.


Figure 1
Figure 1. Unadjusted Relationship Between Area Deprivation Index (ADI) Percentile of a Medicare Patient's Neighborhood and 30 Day Rehospitalization
*On the ADI percentile range shown, 0 is the least socioeconomically disadvantaged group of neighborhoods ranging sequentially by equally sized neighborhood groupings up to 100 as the most disadvantaged group of neighborhoods. ‘Average’ lines represent the averaged relationship over each 5 ADI percentiles. Abbreviation: CHF = Congestive Heart Failure; AMI = Acute Myocardial Infarction; PNA = Pneumonia
Figure 2
Figure 2. Locations of the 15% Most Disadvantaged Neighborhoods Based on Census Block Group Area Deprivation Index (ADI) Score
*Urban block groups/neighborhoods must be viewed at higher magnification within this figure, because they comprise smaller geographic areas than their rural counterparts. Enlargements of sample urban areas are offered to demonstrate.

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