Higher neighborhood-level poverty is associated with higher ambulatory care-sensitive hospitalization rates for New York City residents

background

In New York City (NYC), more than 10% of adult hospitalizations are for conditions such as diabetes, hypertension and asthma that might not have required hospitalization if they had been better managed in an outpatient setting. We examined rates of such ambulatory care-sensitive (ACS) hospitalizations by neighborhood-level poverty overall and by condition.

methods

ACS conditions were defined using Agency for Healthcare Research and Quality’s Prevention Quality Indicators for adults. The New York State Department of Health’s Statewide Planning and Research Cooperative System provided hospitalization data. Rates of ACS hospitalizations were calculated by neighborhood-level poverty for any ACS condition (overall composite), as well as for diabetes, circulatory, respiratory, and acute condition composites. Neighborhood-level poverty was obtained using the American Community Survey and grouped into four levels: low (<10% of residents with incomes <100% of the Federal Poverty Level); medium (10-<20%); high (20-<30%); very high (≥30%). Population denominators for rates by year were created by the NYC health department interpolated intercensal population estimates. Rates were age-adjusted to the US 2000 Standard Population. 

results

From 2007 to 2011, ACS hospitalization rates per 100,000 persons declined overall, by condition, and across all poverty levels. However, higher neighborhood poverty is generally associated with higher rates of ACS hospitalizations compared with low poverty neighborhoods. In addition, this very high/low poverty neighborhood gradient varied by condition type (diabetes, respiratory, circulatory and acute conditions).  Our findings include specific results of analyses of ACS hospitalization rates by neighborhood poverty level, condition types and sex. 

conclusion

Our analyses demonstrate that high-poverty neighborhoods generally have ACS hospitalization rates more than twice the rates in low-poverty neighborhoods, though this can be higher for certain types of ACS conditions. As ACS hospitalization rates are believed to indicate inadequate utilization of high quality ambulatory care services, this analysis suggests that access to and utilization of appropriate outpatient services may be particularly challenging for residents of high-poverty neighborhoods. Interventions that increase appropriate primary care utilization for residents of high-poverty neighborhoods may be particularly helpful in reducing ACS hospitalizations and improving health outcomes.