Abstract
Importance Considerable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited.
Objective To measure how and where sorting of older Black patients to different hospitals occurs within the same health care market.
Design, Setting, and Participants This retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital’s admissions and the racial composition of the hospital’s market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024.
Exposure Degree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status.
Main Outcomes and Measures The LHS index by hospital and a regional LHS index by hospital referral region.
Citation
Akré EL, Chyn D, Carlos HA, Barnato AE, Skinner J. Measuring Local-Area Racial Segregation for Medicare Hospital Admissions. JAMA Netw Open. 2024;7(4):e247473. doi:10.1001/jamanetworkopen.2024.7473
