Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas

Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of U.S. neighborhood socioeconomic disadvantage are more readily available but are rarely used clinically.

A growing body of evidence has shown that neighborhood characteristics have significant effects on quality metrics evaluating health plans or health care providers. Using a data set of an urban teaching hospital patient discharges, this study aimed to determine whether a significant effect of neighborhood characteristics, measured by the Area Deprivation Index, could be observed on patients’ readmission risk, independent of patient-level clinical and demographic factors. We found that patients residing in the more disadvantaged neighborhoods had significantly higher 30-day readmission risks, compared to those living in the less disadvantaged neighborhoods, even after accounting for individual-level factors. Those living in the most extremely socioeconomically challenged neighborhoods were 70 percent more likely to be readmitted than their counterparts who lived in the less disadvantaged neighborhoods. Our findings suggest that neighborhood-level factors should be considered along with individual-level factors in future work on adjustment of quality metrics for social risk factors.

Cytomegalovirus (CMV) is the most common infectious cause of fetal malformations and childhood hearing loss. CMV is more common among socially disadvantaged groups, and geographically clusters in poor communities. The Area Deprivation Index (ADI) is a neighborhood-level index derived from census data that reflects material disadvantage.