Innovation in aging · 2026
When context matters: social disparities in preventable hospitalizations among Medicare beneficiaries with dementia.
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Kalesnikava Viktoryia A, Madden Brian, Vugdalic Nela, Lin Paul, Mahmoudi Elham
Аннотация
BACKGROUND AND OBJECTIVES: We examined geographic variation in the risk of potentially preventable hospitalization (PPH) among individuals with Alzheimer's disease and related dementias.
RESEARCH DESIGN AND METHODS: In this cross-sectional study, we analyzed a 20% random sample of 2017-2018 traditional Medicare claims (n = 67,110), merged with the Area Health Resource File and National Neighborhood Data Archive. Multivariable generalized estimating equation models adjusted for age, sex, frailty index, rurality (metropolitan; micropolitan; rural), and county-level numbers of primary care physicians and hospitals. PPH risk was assessed for the overall cohort, residents of highly disadvantaged areas, and those in rural-or-micropolitan areas.
RESULTS: One-third of hospitalizations were PPHs. Urinary tract infection (33.8%), heart failure (25.7%), and pneumonia (18.6%) accounted for 78% of all PPHs. Unadjusted PPH rates were higher in highly disadvantaged areas (23.9%) compared to low-disadvantaged areas (20.6%). In the overall sample, Black and Hispanic individuals had higher odds of PPH than White individuals, as did those in highly disadvantaged areas compared to low-disadvantaged areas. Among highly disadvantaged urban and rural-or-micropolitan area residents, adjusted PPH rates were 23% and 27%, respectively. Odds of PPH were markedly higher in highly disadvantaged rural-or-micropolitan areas compared with low-disadvantaged areas. Racial/ethnic disparities diminished in these areas, while risk increased for female adults compared with male adults.
DISCUSSION AND IMPLICATIONS: The highest PPH risk occurred in highly disadvantaged rural-or-micropolitan areas. Although racial/ethnic disparities were attenuated in these populations, the overall PPH risk was elevated. Policy efforts should prioritize expanding access to ambulatory care in disadvantaged areas.
RESEARCH DESIGN AND METHODS: In this cross-sectional study, we analyzed a 20% random sample of 2017-2018 traditional Medicare claims (n = 67,110), merged with the Area Health Resource File and National Neighborhood Data Archive. Multivariable generalized estimating equation models adjusted for age, sex, frailty index, rurality (metropolitan; micropolitan; rural), and county-level numbers of primary care physicians and hospitals. PPH risk was assessed for the overall cohort, residents of highly disadvantaged areas, and those in rural-or-micropolitan areas.
RESULTS: One-third of hospitalizations were PPHs. Urinary tract infection (33.8%), heart failure (25.7%), and pneumonia (18.6%) accounted for 78% of all PPHs. Unadjusted PPH rates were higher in highly disadvantaged areas (23.9%) compared to low-disadvantaged areas (20.6%). In the overall sample, Black and Hispanic individuals had higher odds of PPH than White individuals, as did those in highly disadvantaged areas compared to low-disadvantaged areas. Among highly disadvantaged urban and rural-or-micropolitan area residents, adjusted PPH rates were 23% and 27%, respectively. Odds of PPH were markedly higher in highly disadvantaged rural-or-micropolitan areas compared with low-disadvantaged areas. Racial/ethnic disparities diminished in these areas, while risk increased for female adults compared with male adults.
DISCUSSION AND IMPLICATIONS: The highest PPH risk occurred in highly disadvantaged rural-or-micropolitan areas. Although racial/ethnic disparities were attenuated in these populations, the overall PPH risk was elevated. Policy efforts should prioritize expanding access to ambulatory care in disadvantaged areas.