Disparities in Antiemetic Prophylaxis Care Processes Predicted by Patient Neighborhood: Retrospective Cohort and...

Area of Science:

• Healthcare disparities research
• Geospatial analysis in public health
• Perioperative medicine

Background:

• Social determinants of health significantly impact perioperative care, leading to persistent disparities.
• Previous research identified racial and socioeconomic disparities in perioperative processes, including antiemetic prophylaxis administration.
• Neighborhood segregation in the US necessitates examining geospatial clustering of these disparities.

Purpose of the Study:

• To determine if perioperative antiemetic prophylaxis disparities exhibit geographic clustering based on neighborhood disadvantage.
• To assess if patients from disadvantaged communities are more likely to be undertreated for postoperative nausea and vomiting, adjusting for individual risk.
• To investigate the spatial patterns of antiemetic undertreatment in perioperative care.

Main Methods:

• Retrospective cohort study of 19,477 anesthetic records from the University of Utah Hospital.
• Geocoding of patient addresses linked with census block group-level neighborhood disadvantage index from the National Neighborhood Data Archive.
• Application of Poisson spatial scan statistics to detect geographic clusters of antiemetic undertreatment, stratified by risk score.

Main Results:

• A significant geographic cluster (P<.001) of undertreated perioperative antiemetic prophylaxis cases was identified.
• Patients within this cluster were 1.44 times more likely to receive fewer antiemetics, controlling for antiemetic risk.
• Patients from more disadvantaged neighborhoods were more likely to receive below-median antiemetic prophylaxis, even after risk adjustment.

Conclusions:

• This study is the first geospatial cluster analysis of perioperative process disparities.
• Innovative geostatistical methods identified a spatially defined cluster of patients experiencing antiemetic prophylaxis disparities.
• Neighborhood deprivation index predicted disparities in risk-adjusted antiemetic prophylaxis, underscoring the link between geography and care inequities.