When context matters: social disparities in preventable hospitalizations among Medicare beneficiaries with dementia

We examined geographic variation in the risk of potentially preventable hospitalization (PPH) among individuals with Alzheimer's disease and related dementias.

In this cross-sectional study, we analyzed a 20% random sample of 2017-2018 traditional Medicare claims (n = 67,110), merged with the Area Health Resource File and National Neighborhood Data Archive. Multivariable generalized estimating equation models adjusted for age, sex, frailty index, rurality (metropolitan; micropolitan; rural), and county-level numbers of primary care physicians and hospitals. PPH risk was assessed for the overall cohort, residents of highly disadvantaged areas, and those in rural-or-micropolitan areas.

One-third of hospitalizations were PPHs. Urinary tract infection (33.8%), heart failure (25.7%), and pneumonia (18.6%) accounted for 78% of all PPHs. Unadjusted PPH rates were higher in highly disadvantaged areas (23.9%) compared to low-disadvantaged areas (20.6%). In the overall sample, Black and Hispanic individuals had higher odds of PPH than White individuals, as did those in highly disadvantaged areas compared to low-disadvantaged areas. Among highly disadvantaged urban and rural-or-micropolitan area residents, adjusted PPH rates were 23% and 27%, respectively. Odds of PPH were markedly higher in highly disadvantaged rural-or-micropolitan areas compared with low-disadvantaged areas. Racial/ethnic disparities diminished in these areas, while risk increased for female adults compared with male adults.

The highest PPH risk occurred in highly disadvantaged rural-or-micropolitan areas. Although racial/ethnic disparities were attenuated in these populations, the overall PPH risk was elevated. Policy efforts should prioritize expanding access to ambulatory care in disadvantaged areas.