title: Hospitalization for gastrointestinal and liver diseases: the effect of socioeconomic and medical supply factors.
abstract: A growing body of research has documented significant variation in health care use between communities. As the health care system is transformed, providers and payers should understand the interaction between a community, its sociodemographic characteristics, and its use of health resources. We describe the association between a population's demographic, socioeconomic, and medical resources and hospital use related to gastrointestinal and liver diseases. We used an all-payer hospital discharge database for Michigan from 1986 to 1988. We identified all medical and surgical hospital admissions during this period from two of the Diagnostic Related Group, Major Diagnostic Categories: No. 6, Diseases and Disorders of the Digestive System; and No. 7, Diseases and Disorders of the Hepatobiliary System and Pancreas. We analyzed age- and sex-specific use rates. Finally, we analyzed the influence of sociodemographic variables from the Area Resource File at the county level, on hospital use, using a Poisson regression model. We noted a significant association between increased hospitalizations and increased age in a community. Hospital beds per capita did not influence admission rates overall, although more hospital beds were associated with more medical admissions. Overall, the total physician supply was associated with more admissions. Finally, the most important socioeconomic variable was education. As the level of education of a county increased, hospital admissions decreased dramatically. The transformation of the health care delivery system presents opportunities and challenges. Understanding the underlying epidemiology of disease and how it interacts with a community's socioeconomic and medical resources or medical supply characteristics will be necessary to meet the community's health needs and to ensure the financial viability of providers. This is especially true when payers use a standard payment in a region, such as Medicare's managed care payment, without adjustments for the underlying population characteristics known to influence use.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: McMahon
authors.forename: R
authors.initials: R
authors.lastname: Wolfe
authors.forename: S
authors.initials: S
authors.lastname: Huang
authors.forename: P
authors.initials: P
authors.lastname: Tedeschi
authors.forename: W
authors.initials: W
authors.lastname: Manning
authors.forename: M
authors.initials: M
authors.lastname: Edlund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D019538:Health Care Surveys; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012959:Socioeconomic Factors