Neighborhood Socioeconomic Deprivation and 30-Day Outcomes After Admission for Common Gastrointestinal Conditions: A Large Nationwide Study.

BACKGROUND AND AIMS: To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to health-care resources, and treatment facility characteristics.

METHODS

We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017 to 2019 for common gastrointestinal diseases, grouped by diagnosis-related groups. We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index, with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multistep adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient health-care resources, and hospital-level characteristics.

RESULTS

In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for nonmalignant pancreatic disorders (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.25-2.01), esophageal disorders (OR 1.50, 95% 1.02-2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29-1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16-1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.

CONCLUSION

We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to health-care resources, and characteristics of treating facilities.