Hospitals alike, hospitals different: spatial clustering of inequality around Boston's hospitals

This brief research report investigates how racial and socioeconomic segregation shape spatial inequalities in health outcomes and healthcare access across Boston, Massachusetts. It examines the spatial clustering of race, poverty, and poor health, and analyzes how these patterns align with the locations of major hospitals in the city. We integrated data from the 2018-2022 American Community Survey, CDC PLACES, and the Massachusetts Center for Health Information and Analysis (CHIA) for all non-specialized acute care hospitals in Boston. Spatial autocorrelation was assessed using Global Moran's I statistics and Bivariate Local Indicators of Spatial Association (BiLISA) maps to identify co-clustering of non-White population, poverty, and poor health at the census tract level. All three measures showed statistically significant positive spatial autocorrelation (p < 0.001), confirming moderate-strong spatial clustering across Boston. Bivariate maps show racial composition, poverty, and poor health outcomes to have significant spatial clustering around hospitals. Historical segregation patterns still exist to this day and shape how people receive healthcare in the city. Patterns around recently closed Carney Hospital further underscored the spatial burden of care redistribution. Safety-net hospitals disproportionately serve neighborhoods with the greatest health and economic vulnerabilities while wealthier hospitals are embedded in healthier areas. These findings highlight the need for interhospital collaboration, equitable resource distribution, and policy interventions that explicitly address the spatial legacy of structural racism in healthcare delivery in American cities.