Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011

Objectives To study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income.Design Serial cross-sectional study testing the association between hospitalisation rates and zip c...

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Main Authors: Eva Raphael, R Gaynes
Format: Article
Language:English
Published: BMJ Publishing Group 2019-10-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/9/10/e031556.full
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author Eva Raphael
R Gaynes
author_facet Eva Raphael
R Gaynes
author_sort Eva Raphael
collection DOAJ
description Objectives To study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income.Design Serial cross-sectional study testing the association between hospitalisation rates and zip code-level median income, with subgroup analyses by zip code income and race.Participants/setting Our study included all hospitalised adults over 18 years old living in California in 2001 and 2011 who were not pregnant or incarcerated. This included all acute-care hospitalisations in California including 1632 zip codes in 2001 and 1672 zip codes in 2011.Primary and secondary outcomes We compared age-standardised hospitalisations per 100 000 persons, overall and for several disease categories.Results There were 1.58 and 1.78 million hospitalisations in California in 2001 and 2011, respectively. Spatial analysis showed the highest hospitalisation rates in urban inner cities and rural areas, with more than 5000 hospitalisations per 100 000 persons. Hospitalisations per 100 000 persons were consistently highest in the lowest zip code income quintile and particularly among black patients.Conclusion Hospitalisation rates rose from 2001 to 2011 among Californians living in low-income and middle-income zip codes. Integrating spatially defined state hospital discharge and federal zip code income data provided a granular description of disease burden. This method may help identify high-risk areas and evaluate public health interventions targeting health disparities.
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spelling doaj-art-664cf49b408c4bff87c6013c0d5332d22024-12-14T05:20:09ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2019-031556Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011Eva Raphael0R Gaynes11 Family and Community Medicine, University of California San Francisco, San Francisco, California, USA2 Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USAObjectives To study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income.Design Serial cross-sectional study testing the association between hospitalisation rates and zip code-level median income, with subgroup analyses by zip code income and race.Participants/setting Our study included all hospitalised adults over 18 years old living in California in 2001 and 2011 who were not pregnant or incarcerated. This included all acute-care hospitalisations in California including 1632 zip codes in 2001 and 1672 zip codes in 2011.Primary and secondary outcomes We compared age-standardised hospitalisations per 100 000 persons, overall and for several disease categories.Results There were 1.58 and 1.78 million hospitalisations in California in 2001 and 2011, respectively. Spatial analysis showed the highest hospitalisation rates in urban inner cities and rural areas, with more than 5000 hospitalisations per 100 000 persons. Hospitalisations per 100 000 persons were consistently highest in the lowest zip code income quintile and particularly among black patients.Conclusion Hospitalisation rates rose from 2001 to 2011 among Californians living in low-income and middle-income zip codes. Integrating spatially defined state hospital discharge and federal zip code income data provided a granular description of disease burden. This method may help identify high-risk areas and evaluate public health interventions targeting health disparities.https://bmjopen.bmj.com/content/9/10/e031556.full
spellingShingle Eva Raphael
R Gaynes
Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
BMJ Open
title Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
title_full Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
title_fullStr Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
title_full_unstemmed Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
title_short Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011
title_sort cross sectional analysis of place based and racial disparities in hospitalisation rates by disease category in california in 2001 and 2011
url https://bmjopen.bmj.com/content/9/10/e031556.full
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AT rgaynes crosssectionalanalysisofplacebasedandracialdisparitiesinhospitalisationratesbydiseasecategoryincaliforniain2001and2011