TY - JOUR
T1 - The Association Between Neighborhood Socioeconomic and Housing Characteristics with Hospitalization
T2 - Results of a National Study of Veterans
AU - Hatef, Elham
AU - Kharrazi, Hadi
AU - Nelson, Karin
AU - Sylling, Philip
AU - Ma, Xiaomeng
AU - Lasser, Elyse C.
AU - Searle, Kelly M.
AU - Predmore, Zachary
AU - Batten, Adam J.
AU - Curtis, Idamay
AU - Fihn, Stephan
AU - Weiner, Jonathan P.
PY - 2019/11/11
Y1 - 2019/11/11
N2 - BACKGROUND: Social determinants of health (SDOH) have an inextricable impact on health. If remained unaddressed, poor SDOH can contribute to increased health care utilization and costs. We aimed to determine if geographically derived neighborhood level SDOH had an impact on hospitalization rates of patients receiving care at the Veterans Health Administration's (VHA) primary care clinics. METHODS: In a 1-year observational cohort of veterans enrolled in VHA's primary care medical home program during 2015, we abstracted data on individual veterans (age, sex, race, Gagne comorbidity score) from the VHA Corporate Data Warehouse and linked those data to data on neighborhood socioeconomic status (NSES) and housing characteristics from the US Census Bureau on census tract level. We used generalized estimating equation modeling and spatial-based analysis to assess the potential impact of patient-level demographic and clinical factors, NSES, and local housing stock (ie, housing instability, home vacancy rate, percentage of houses with no plumbing, and percentage of houses with no heating) on hospitalization. We defined hospitalization as an overnight stay in a VHA hospital only and reported the risk of hospitalization for veterans enrolled in the VHA's primary care medical home clinics, both across the nation and within 1 specific case study region of the country: King County, WA. RESULTS: Nationally, 6.63% of our veteran population was hospitalized within the VHA system. After accounting for patient-level characteristics, veterans residing in census tracts with a higher NSES index had decreased odds of hospitalization. After controlling all other factors, veterans residing in census tracts with higher percentage of houses without heating had 9% (Odds Ratio, 1.09%; 95% CI, 1.04 to 1.14) increase in the likelihood of hospitalization in our regional Washington State analysis, though not our national level analyses. CONCLUSIONS: Our results present the impact of neighborhood characteristics such as NSES and lack of proper heating system on the likelihood of hospitalization. The application of placed-based data at the geographic level is a powerful tool for identification of patients at high risk of health care utilization.
AB - BACKGROUND: Social determinants of health (SDOH) have an inextricable impact on health. If remained unaddressed, poor SDOH can contribute to increased health care utilization and costs. We aimed to determine if geographically derived neighborhood level SDOH had an impact on hospitalization rates of patients receiving care at the Veterans Health Administration's (VHA) primary care clinics. METHODS: In a 1-year observational cohort of veterans enrolled in VHA's primary care medical home program during 2015, we abstracted data on individual veterans (age, sex, race, Gagne comorbidity score) from the VHA Corporate Data Warehouse and linked those data to data on neighborhood socioeconomic status (NSES) and housing characteristics from the US Census Bureau on census tract level. We used generalized estimating equation modeling and spatial-based analysis to assess the potential impact of patient-level demographic and clinical factors, NSES, and local housing stock (ie, housing instability, home vacancy rate, percentage of houses with no plumbing, and percentage of houses with no heating) on hospitalization. We defined hospitalization as an overnight stay in a VHA hospital only and reported the risk of hospitalization for veterans enrolled in the VHA's primary care medical home clinics, both across the nation and within 1 specific case study region of the country: King County, WA. RESULTS: Nationally, 6.63% of our veteran population was hospitalized within the VHA system. After accounting for patient-level characteristics, veterans residing in census tracts with a higher NSES index had decreased odds of hospitalization. After controlling all other factors, veterans residing in census tracts with higher percentage of houses without heating had 9% (Odds Ratio, 1.09%; 95% CI, 1.04 to 1.14) increase in the likelihood of hospitalization in our regional Washington State analysis, though not our national level analyses. CONCLUSIONS: Our results present the impact of neighborhood characteristics such as NSES and lack of proper heating system on the likelihood of hospitalization. The application of placed-based data at the geographic level is a powerful tool for identification of patients at high risk of health care utilization.
KW - Cohort Studies
KW - Comorbidity
KW - Hospitalization
KW - Housing Issues
KW - Patient-Centered Care
KW - Population Health
KW - Primary Health Care
KW - Social Determinants of Health
KW - Socioeconomic Status
KW - United States Department of Veterans Affairs
KW - Veterans Health
KW - Washington
UR - http://www.scopus.com/inward/record.url?scp=85074742396&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85074742396&partnerID=8YFLogxK
U2 - 10.3122/jabfm.2019.06.190138
DO - 10.3122/jabfm.2019.06.190138
M3 - Article
C2 - 31704758
SN - 1557-2625
VL - 32
SP - 890
EP - 903
JO - Journal of the American Board of Family Medicine : JABFM
JF - Journal of the American Board of Family Medicine : JABFM
IS - 6
ER -