Mapping Health Disparities:: Leveraging Area-Based Deprivation Indices for Targeted Chronic Disease Intervention.

Abstract

This article addresses the critical link between socioeconomic status and health outcomes in chronic disease patients, emphasizing the need for system-level outcome measurement stratified by socioeconomic status. Despite the acknowledged influence of social determinants, there is a lack of published studies analyzing chronic disease outcomes neighborhood by neighborhood. The importance of mapping as a public health tool, and the significance of analyzing outcomes at the neighborhood level is emphasized. The U.S. Census Bureau's hierarchy of space definitions is presented, particularly focusing on census tracts as a unique opportunity for analyzing chronic disease outcomes. Two Area-Based Deprivation Indices (ABDIs) - the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI) - as tools to measure socioeconomic disadvantage and vulnerability to environmental stressors, respectively are described. A brief survey of the weaknesses of ABDIs and limitations in addressing individual-level factors is addressed followed by a discussion of the challenges in translating patient address data into census block data. The evolving conversation around equity analysis and its impact on chronic disease management is presented. It highlights the willingness of public payers to tie payments to ABDIs, signaling a shift towards a more equitable healthcare system. Private insurers and health systems are urged to invest in geocoding strategies to understand and improve outcomes for the diverse neighborhoods they serve, acknowledging that the path forward involves addressing health disparities at the population level.