Geriatric orthopaedic surgery & rehabilitation · 2025
Elevated Distressed Community Index Score is Associated With Adverse Outcomes Following Hip Fracture Surgery in the Medicare Population.
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Gray Mitchell T, Bonsu Janice M, Malik Azeem Tariq, Ly Thuan V, Phieffer Laura S, Harrison Ryan K, Khan Safdar, Quatman Carmen E
Аннотация
BACKGROUND: Despite advances in surgical care, disparities in functional recovery and mortality following hip fracture directly relate to racial, ethnic, and economic factors. Without a comprehensive method to model patients' diverse socioeconomic factors, researchers rely on proxies such as race and insurance status. The Distressed Community Index (DCI) score is a validated means of holistically estimating a patient's socioeconomic status, incorporating variables including community median income, unemployment, housing vacancies, education, business growth, and poverty rates.
METHODS: The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and >80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality.
RESULTS: A total of 364 074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12; P < 0.001), pneumonia (OR 1.18; P < 0.001), and pressure ulcers (OR 1.09; P < 0.001). Patients in the distressed group were more likely to have emergency department visits (OR 1.12; P < 0.001) and had higher odds of mortality (OR 1.14; P < 0.001). With elevated DCI score there were lower rates of readmission (OR 0.91-0.95; P < 0.001) but this was not significant in the DCI >80 group.
CONCLUSIONS: Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.
METHODS: The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and >80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality.
RESULTS: A total of 364 074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12; P < 0.001), pneumonia (OR 1.18; P < 0.001), and pressure ulcers (OR 1.09; P < 0.001). Patients in the distressed group were more likely to have emergency department visits (OR 1.12; P < 0.001) and had higher odds of mortality (OR 1.14; P < 0.001). With elevated DCI score there were lower rates of readmission (OR 0.91-0.95; P < 0.001) but this was not significant in the DCI >80 group.
CONCLUSIONS: Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.