Upstream Drivers of Receiving Care in Minority-Serving Hospitals: a Cross-Sectional Study Using MCBS Data

TL;DR

This study finds that race, insurance status, and neighborhood disadvantage are linked to hospitalization in minority-serving hospitals, with significant differences by race.

Contribution

The study identifies upstream socio-structural factors influencing care in minority-serving hospitals and highlights racial disparities.

Findings

Black patients had higher odds of hospitalization in MSH compared to White patients.

Neighborhood disadvantage and residential segregation were strongly associated with MSH hospitalization.

The effect of segregation and disadvantage on MSH hospitalization varied significantly by race.

Abstract

Racial separation of care contributes to racial disparities in health. Little is known about upstream drivers of receiving care in a minority-serving hospital (MSH) and differences by race/ethnicity.

Cross-sectional analysis of MCBS data (2010-2019) with binary outcome of hospitalization in MSH versus not. Exposures of interest were individual race/ethnicity and insurance; neighborhood disadvantage (SDI); and regional residential racial segregation. We included individual and regional covariates. In fully adjusted models, we tested whether race/ethnicity modified the association between SDI or residential segregation and hospitalization in MSH.

Among 8,735 hospitalizations, race/ethnicity (aOR 3.19 for Black vs. White patients; 95% Confidence Interval (CI): 2.60-3.91; P < 0.001); dual-eligible status (aOR: 1.30, 95% CI: 1.05-1.60; P < 0.05), neighborhood disadvantage (aOR for most disadvantaged versus least: 2.03, 95% CI: 1.56-2.63, P < 0.001); and residential segregation (aOR for high segregation versus low: 2.99, 95% CI: 1.98-4.52; P < 0.001) were independently associated with hospitalization in MSH. In the least disadvantaged or segregated areas, all patients were unlikely to be hospitalized in MSH; however, in the most disadvantaged or segregated areas, White patients had only a small increase in odds of MSH hospitalization while Black patients had a very large increase (P for interaction terms = 0.001 and 0.04, respectively).

Our findings on differences by race/ethnicity suggest a need for further research on factors driving site of care, to address the upstream socio-structural determinants of health, and to invest in minority-serving hospitals given the practical challenges of eliminating neighborhood disadvantage and residential segregation.