Decisions to hospitalize and operate: a socioeconomic perspective in an urban state

Rates of hospital discharges for selected surgical procedures and some medical conditions were compared by socioeconomic status (SES) of patients for all 1972 hospital discharges from the 13 voluntary general hospitals located in Rhode Island. Socioeconomic status was determined by scoring the census tract of patient residence with such variables as median family income, housing status, etc. Many frequently performed surgical procedures had similar rates for the high, middle, low, and poverty socioeconomic groups. Procedures performed more frequently on the poverty than on the high SES group were tonsillectomy and upper gastrointestinal, heart, hemorrhoid, and cataract procedures. Dental procedures were performed more frequently on the high SES group. The over-all rate of hospital admissions showed a steady decline from the rate of 156 per 1,000 for the poverty census tracts to 104 for the high SES census tracts. This trend was reflected in the admission rates for several conditions requiring primary medical management, such as infections, diabetes, and skin problems. The population-based frame of reference used in this study can be a useful tool for raising pertinent questions for both professional standards review organizations and health planning groups.