title: Area income as a predictor of preventable hospitalizations in the Harris County Hospital District, Houston.
abstract: This study assesses whether geographical area income based on census data is a good predictor of preventable (or ambulatory care-sensitive) hospitalizations in a large public hospital system in Texas, and how area income correlates with the socioeconomic status reported by patients. Documenting a correspondence between area and individual-level income, as well as meaningful variation in rates of avoidable hospitalizations across subgroups and areas with varying concentrations of low-income persons, points to the validity and utility of this approach for monitoring how well public hospital systems in Texas address the needs of those they most directly serve. Area income may not fully reflect the disproportionately lower socioeconomic status of patients seen in the public hospital system. Nonetheless, living in lower-income zip codes was associated with higher preventable hospitalization rates for the predominantly low-income population served by the public hospital system. A tenfold difference found in the adjusted rates of hospitalizations for preventable conditions compared with control (or marker) conditions among persons living in low-income areas signals the likelihood of substantial unmet needs in this population. Small-area analysis and related comparisons of rates of preventable hospitalizations in high- and low-income areas provide useful indicators for monitoring and assessing the performance of public hospital systems in Texas.
authors.affiliation: University of Texas-Houston School of Public Health, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Djojonegoro
authors.forename: L A
authors.initials: LA
authors.lastname: Aday
authors.forename: A F
authors.initials: AF
authors.lastname: Williams
authors.forename: C E
authors.initials: CE
authors.lastname: Ford
mesh_terms: D000553:Ambulatory Care; D019352:Censuses; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D011203:Poverty; D012959:Socioeconomic Factors; D013781:Texas