Examining rurality, social vulnerability and ambulatory care sensitive conditions in Georgia communities

Introduction and Background: Ambulatory care sensitive conditions (ACS), with proper outpatient care, should not normally require inpatient admissions or emergency room visits.   Purpose: The purpose of this descriptive study was to examine the association of rurality and social vulnerability with hospitalization rates for ACS conditions in 159 counties in the state of Georgia. To our knowledge, this is the first study to examine the relationship with social vulnerability index and ACS conditions. We hypothesized that counties with high levels of social vulnerability have poor access to outpatient care and consequently higher rates of hospitalizations for the ACS conditions.  Data and Methods: Georgia hospital data, summarized for all 159 counties for the years 2009-2011, were merged with the Social Vulnerability Index (SoVI) and analyzed using bivariate correlation coefficients, Chi-square (for urbanization levels) and multiple linear regression, SPSS Version 21. Social vulnerability index comprises 30 indicators of socio-demographic and economic status (such as race, age, ethnicity, special needs, wealth, poverty etc.). Results show that social vulnerability is significantly associated with hospitalization for ambulatory care conditions, both at bivariate (r=0.595),  and multivariate level (B=0.6; p=0.000). Rural status of the community was also positively associated with percent of hospital discharges for ambulatory care conditions, as residence with any level of urbanization (large metro; medium metro, micropolitan, small metro) was negatively associated with percent of discharges with ACS conditions. Conclusions: Social vulnerability and rurality are strong predictors of unnecessary hospitalizations in communities with vulnerable populations. Our findings have strong implications for the health disparities.