Neighborhood Socioeconomic Deprivation and 30-Day Outcomes After Admission for Common Gastrointestinal Conditions: A Large Nationwide Study

Abstract

Background and Aims

To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to healthcare resources, and treatment facility characteristics.

Methods

We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017-2019 for common gastrointestinal diseases, grouped by Diagnosis Related Groups (DRGs). We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index (ADI), with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multi-step adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient healthcare resources, and hospital-level characteristics.

Results

In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully-adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for non-malignant pancreatic disorders (OR 1.59, 95% CI 1.25-2.01), esophageal disorders (OR 1.50, 95% 1.02-2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29-1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16-1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.

Conclusion

We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to healthcare resources, and characteristics of treating facilities.