Study Links Poverty to Higher Hospitalization Rates

Researchers call on hospitals to embrace 'culture of health' as well as reforms and care redesign to help address income-related healthcare disparity.

Poverty is associated with higher rates of inpatient stays for pediatric patients, and hospital reforms can help address the problem, according to an article published this week in Health Affairs.

The study focuses on Hamilton County, Ohio, which includes Cincinnati and has a population of about 190,000 children. For the period 2011 to 2016, the researchers collected data from all pediatric hospitalizations at Cincinnati Children’s Hospital Medical Center, then paired each pediatric patient with a Census tract.

"Poorer communities disproportionately bore the burden of pediatric hospital days," the researchers wrote. "If children from all of the county’s census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately 22 child-years of hospitalization time would be prevented [annually]."

Bed-day is a key metric in the study and is calculated by dividing the number of days that children from a community are hospitalized by the total number of children living in the community.

Bed-day data shows that pediatric patients from Hamilton County's low-income areas are disproportionately more likely to be hospitalized:

• Low poverty: 87.7 per 1,000 children per year
• Low medium poverty: 113.3 per 1,000
• Medium poverty: 130.7 per 1,000
• High medium poverty: 144.1 per 1,000
• High poverty: 171.4 per 1,000

Addressing Income-Related Disparity

The researchers identified several poverty "hot spots" near the medical center, and the 628-bed facility has launched several initiatives to better serve the disadvantaged neighborhoods.

In Avondale, which borders the medical center on three sides, bed-day rates are more than double the county average. The medical center has targeted Avondale for population health improvement efforts as well as tighter community partnerships with schools, primary care practices, and pharmacies.

The researchers call for a "culture of health" at hospitals as foundational to addressing income-related disparity.

"This may require an expanded focus on inpatient-to-outpatient transitions and community-connected work that gets to shared root causes affecting disparities across conditions and subspecialties. Such an approach may be more fruitful than attempting to tackle disparities condition by condition."

The researchers say that reforms and redesign of care models is needed to serve low-income neighborhoods:

• Enhanced discharge services such as filling prescriptions and arranging follow-up appointments with transportation
• Addressing social determinants with partners such as social workers and community health workers
• Strengthening communication between inpatient and outpatient settings

"In Cincinnati, we have invested in relationships between providers of inpatient and outpatient care; nonprofit organizations; public schools; the local health department; social service agencies; faith-based entities; businesses; and, importantly, parents and families," the researchers wrote.