Expansion of 340B Disproportionate Share Hospitals in the United States From 2010 to 2022

To evaluate how the communities of newly registered 340B Disproportionate Share Hospitals (DSHs), child sites, and contract pharmacies have changed over time on key socioeconomic measures.

Serial cross-sectional analysis from 2010 to 2022 examining yearly change in Social Deprivation Index (SDI).

340B DSHs, child sites, and contract pharmacies were identified in the Office of Pharmacy Affairs and Information System and linked to socioeconomic measures by ZIP code.

Seven hundred and seventy five newly registered 340B DSHs, 29,475 child sites, and 48,214 contract pharmacies were included in the analysis. The SDI of communities with newly registered DSHs remained stable during the study period (median 62). By contrast, the SDI of communities with newly registered child sites decreased from a median of 59 in 2010 to 53 in 2022 (-0.18 centiles per year on linear regression, p < 0.001), and the SDI of communities with newly registered contract pharmacies decreased from a median of 72 in 2010 to 53 in 2022 (-0.69 centiles per year on linear regression, p < 0.001), suggesting expansion into areas with lower social deprivation over time.

340B DSH hospitals have registered new child sites and contract pharmacies in increasingly wealthy areas.