Buckingham William R, Ryan Powell W, Keller Sarah Anne, Hansmann Kelia J, Kind Amy Jh
Center for Health Disparities Research, University of Wisconsin-Madison.
Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison.
Pap Appl Geogr. 2024;10(2):89-95. doi: 10.1080/23754931.2024.2312192. Epub 2024 Feb 8.
Area-level measures of the social exposome provide powerful tools to understand how context contributes to health disparities. Due to the geographic phenomenon of the modifiable aerial unit problem, the geographic level at which the index is constructed can threaten it utility. Previous work indicates that using smaller geographic levels lead to increased measurement precision which may result in closer alignment to policies that directly address health disparities. To provide an illustrative example of this phenomenon, we use Medicare 100% Fee-for Service hospitalization claims data to evaluate the association between area-level disadvantage and 30-day readmissions when the Area Deprivation Index (ADI) is constructed at different geographic levels. When area-level disadvantage is summarized at the "neighborhood" census block group-the study's smallest geographic level-there was a 20% higher odds of readmissions for those living in the top 20% most disadvantaged neighborhoods compared to those living in the lowest 80% neighborhoods nationwide. Yet, evidence for an association with readmissions was not found when neighborhood disadvantaged was summarized at larger geographic levels. Smaller geographic levels appear most optimal to capture these effects. In order to provide publicly available data that is truly publicly useable, greater attention in providing small area health data is needed.
社会暴露组的区域层面测量为理解环境如何导致健康差异提供了有力工具。由于可修改的空间单元问题这一地理现象，构建指数的地理层面可能会影响其效用。先前的研究表明，使用较小的地理层面会提高测量精度，这可能会使指数与直接解决健康差异问题的政策更紧密地保持一致。为了说明这一现象，我们使用医疗保险100%按服务付费住院理赔数据，评估在不同地理层面构建区域剥夺指数（ADI）时，区域层面的劣势与30天再入院率之间的关联。当在研究中最小的地理层面——“邻里”普查街区组——汇总区域层面的劣势时，生活在全国最贫困的20%邻里中的人群，其再入院几率比生活在最不贫困的80%邻里中的人群高出20%。然而，当在更大的地理层面汇总邻里劣势时，未发现与再入院率相关的证据。较小的地理层面似乎最适合捕捉这些影响。为了提供真正可供公众使用的公开数据，需要更加关注提供小区域健康数据。
