# Neighborhood Socioeconomic Deprivation and 30-Day Outcomes After Admission for Common Gastrointestinal Conditions: A Large Nationwide Study

## TL;DR

This study shows that living in a deprived neighborhood is linked to higher 30-day mortality for common GI conditions, even after adjusting for individual and healthcare factors.

## Contribution

The study demonstrates that neighborhood socioeconomic deprivation independently affects 30-day mortality for GI diseases beyond individual-level factors.

## Key findings

- Neighborhood deprivation is associated with higher 30-day mortality for nonmalignant pancreatic disorders, esophageal disorders, gastrointestinal hemorrhage, and biliary tract disorders.
- The association between neighborhood deprivation and mortality remains significant after adjusting for individual poverty, demographics, comorbidities, and healthcare access.
- Neighborhood deprivation was not linked to 30-day readmission after full adjustment.

## Abstract

To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to health-care resources, and treatment facility characteristics.

We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017 to 2019 for common gastrointestinal diseases, grouped by diagnosis-related groups. We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index, with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multistep adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient health-care resources, and hospital-level characteristics.

In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for nonmalignant pancreatic disorders (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.25–2.01), esophageal disorders (OR 1.50, 95% 1.02–2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29–1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16–1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.

We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to health-care resources, and characteristics of treating facilities.