Upstream Factors Associated With Hospitalization in Black- and Minority-Serving Hospitals

Area of Science:

• Health Services Research
• Health Disparities
• Social Determinants of Health

Background:

• Racial segregation in healthcare delivery contributes to health inequities.
• Understanding the impact of place-based factors on care utilization is crucial for addressing disparities.

Purpose of the Study:

• To investigate the association between neighborhood disadvantage and residential segregation with hospitalization in Black-serving hospitals (BSH) or minority-serving hospitals (MSH).
• To determine if these associations are modified by patient race/ethnicity or hospitalization type (elective vs. non-elective).

Main Methods:

• Cross-sectional analysis of Medicare Current Beneficiary Survey data (2011-2020) linked with Medicare claims.
• Utilized Social Deprivation Index (SDI) for neighborhood disadvantage and hospital referral region (HRR) for residential segregation.
• Examined effect modification by race/ethnicity and elective status.

Main Results:

• Neighborhood disadvantage and residential segregation were independently associated with higher odds of hospitalization in a BSH.
• These associations were stronger for Black patients compared to White patients, particularly in highly disadvantaged or segregated areas.
• Elective hospitalizations showed weaker associations with place-based factors and race/ethnicity.

Conclusions:

• Place-based factors like neighborhood disadvantage and residential segregation significantly influence where patients receive care, exacerbating racial disparities.
• Targeted interventions addressing these social determinants are needed to promote equitable healthcare access.
• Investment in Black-serving hospitals is essential to mitigate these disparities.