Pervasive Income-Based Disparities In Inpatient Bed-Day Rates Across Conditions And Subspecialties

Health Aff (Millwood). 2018 Apr;37(4):551-559. doi: 10.1377/hlthaff.2017.1280.


Building a culture of health in hospitals means more than participating in community partnerships. It also requires an enhanced capacity to recognize and respond to disparities in utilization patterns across populations. We identified all pediatric hospitalizations at Cincinnati Children's Hospital Medical Center, in the period 2011-16. Each hospitalized child's address was geocoded, allowing us to calculate inpatient bed-day rates for each census tract in Hamilton County, Ohio, across all causes and for specific conditions and pediatric subspecialties. We then divided the census tracts into quintiles based on their underlying rates of child poverty and calculated bed-day rates per quintile. Poorer communities disproportionately bore the burden of pediatric hospital days. If children from all of the county's census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately twenty-two child-years of hospitalization time would be prevented. Of particular note were "hot spots" in high-poverty census tracts neighboring the hospital, where bed-day rates were more than double the county average. Hospitals that address disparities would benefit from a more comprehensive understanding of the culture of health-a culture that is more cohesive inside the hospital and builds bridges into the community.

Keywords: Children’s Health; Determinants Of Health; Disparities; Hospitals.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Algorithms*
  • Child
  • Child, Preschool
  • Female
  • Geographic Mapping*
  • Health Status Disparities*
  • Hospitalization / statistics & numerical data*
  • Hospitals, Pediatric*
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data*
  • Male
  • Ohio
  • Poverty
  • Socioeconomic Factors