Racial disparities in hospitalization and neighborhood deprivation among Medicare beneficiaries

Many neighborhoods with concentrated racial and ethnic minority older adult populations experience high neighborhood disadvantage. Yet, to date, no studies have analyzed how neighborhood disadvantage affects the relationship between race and hospitalization among older adults. To fill this gap, we examined if neighborhood disadvantage moderates the relationship between race and hospitalization among older adults in the United States. Medicare claims data from 2018 on 530 962 beneficiary hospitalizations were merged with neighborhood data, and regression models assessed if the Area Deprivation Index (ADI) moderated the association between race and hospitalization. At the highest ADI score, the odds ratio (OR) for hospitalization for Black compared with White beneficiaries was the lowest (OR: 0.96; 95% CI: 0.89-1.04). At the lowest ADI score, the OR for hospitalization for Black compared with White beneficiaries was the highest (OR: 1.19; 95% CI: 1.09-1.29). When Black and White beneficiaries reside in severely deprived areas, the disparity in their outcomes is narrower. However, when they reside in areas with more advantages, White beneficiaries experience better outcomes than Black beneficiaries. Our findings have implications for practice and policy to invest resources in communities to assure health equity.