Statement of the problem: Hospitalizations for ambulatory care sensitive conditions are preventable because they can be treated in the primary care system. There have been consistent associations between race and location-based characteristics like segregation. Because of this, a study of “hotspots” of PHs is warranted, and the role of race, segregation and a possible mechanism, local health resources, was performed.
Methods: This study analyzed Maryland hospital discharge data to determine the presence of hotspots (i.e. areas with higher PH rates). The adjusted rate of PHs was determined through multi-variate regression on the zip code tabulation area (ZCTA)-level. Segregation was assessed by the Dissimilarity Index (DI score) and racial composition. The association between segregation and PH hotspots was assessed. The effect of local health resources on PH hotspots was assessed. The mediating effects of local health resources on the association between PH rates and segregation were assessed using comparative regression analyses.
Results: There were 10 geographic clusters (or hotspots) of ZCTAs with higher than expected PH rates in the State of Maryland. The location and characteristics of PH hotspots varied by race/ethnicity, but varied little when comparing by PH type. Accounting for segregation reduced the number of PH hotspots. Three of the local health resources were associated with PH rates and hotspots, and, in general, the number of PH hotspots was decreased after adjustment. The association between PH rates and DI scores was reduced after adjusting for associated local health resources, suggesting that these local health resources partially mediated the association between segregation and PH rates.
Conclusions: The results of this study do find PH hotspots in Maryland, and significant inter-relationships between race, segregation, local health resources and PHs in Maryland. PH hotspots can be directly targeted by public health practitioners and policy makers with attention to PH hotspots among African Americans compared to whites, and PH hotspots for acute versus chronic and CVD-related PHs. The presence of local health resources was found to be a mediator of the relationship between segregation and PH rates. Policy makers should consider the potential role of various local health resources on PH.
Committee members: Janice V. Bowie, David M. Levine, Roland J. Thorpe, Jr., C. Debra Furr-Holden, Karin Tobin (alternate), Sara N. Bleich (alternate)
Reader: Frank C. Currier
