TY - JOUR
T1 - Association of the Robert Wood Johnson Foundations’ Social Determinants of Health and Medicare Ocular Hospitalizations
T2 - A Cross Sectional Data Analysis
AU - French, Dustin D.
AU - Wang, Andrew
AU - Prager, Alisa J.
AU - Margo, Curtis E.
N1 - Funding Information:
Dr. French was supported by funding from the Robert Wood Johnson Foundation (Grant Number: 74315) and an unrestricted grant from Research to Prevent Blindness, New York, NY. Research to Prevent Blindness, New York, NY. Andrew Wang is supported by the Agency for Healthcare Research and Quality’s (AHRQ) National Research Service Award Institutional Research T32 Training Grant HS000078/HS000084. The Rapid Service Fees are funded by NU Galter Library. We would like to thank Karl Y. Bilimoria, MD, MS., Director of the Surgical Outcomes Quality Improvement Center ( www.soqic.org ), for his assistance in obtaining the Medicare data.
Funding Information:
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government (French, Margo). Dr. French was supported by funding from the Robert Wood Johnson Foundation (Grant Number: 74315) and an unrestricted grant from Research to Prevent Blindness, New York, NY. Research to Prevent Blindness, New York, NY. Andrew Wang is supported by the Agency for Healthcare Research and Quality’s (AHRQ) National Research Service Award Institutional Research T32 Training Grant HS000078/HS000084. The Rapid Service Fees are funded by NU Galter Library. We would like to thank Karl Y. Bilimoria, MD, MS., Director of the Surgical Outcomes Quality Improvement Center (www.soqic.org), for his assistance in obtaining the Medicare data. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Dustin D. French, Andrew Wang, Alisa J. Prager and Curtis E. Margo declare no conflicts of interest. This study abides by the Dataset Use Agreement (DUA) and the Northwestern University Institutional Review Board, which granted a study exemption. All methods adhered to the tenets of the Declaration of Helsinki. Under Data Use Agreement (CMS-R-0235L) section 8a no cell less than 11 may be displayed. Medicare Limited Data Set (LDS) files contain beneficiary level protected health information and are under Federal regulation through the Health Insurance Portability and Accountability Act; By law, LDS requests require a Data Use Agreement (DUA) available at https://www.resdac.org/cms-data/request/limited-data-sets and require an Institutional Board Waiver. Our study abides by the CMS’ current cell size suppression policy in Data Use Agreement section 8 (DUA), which states that no cell less than 11 may be displayed unless permission is obtained. As such, our study did not require permission from CMS for data use. LDS requests do not require a ResDAC review and can be submitted directly to CMS by the researcher. For further information visit https://www.resdac.org/. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Introduction: Social determinants of health (SDH) may influence inpatient utilization rates and outcomes but have yet to be associated with ocular diagnoses. The purpose of this paper was to determine whether the SDH are associated with ocular hospitalizations. Methods: Patients from the national Medicare 100% Inpatient Limited Dataset were examined and linked to SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Patients were included in the study group with either an admitting or primary diagnosis of an ophthalmic condition. All other hospitalized Medicare patients served in the comparison group. Nested logistic regression of these Medicare patients was conducted in their respective communities at the county level. SDH measures were benchmarked above or below the national median. Results: Positively associated SDH factors included communities with air pollution exceeding 11.62 micro grams per cubic meter (OR 1.05; 95% CI 1.01–1.08), communities where severe housing problems exceeding 14.38% (OR 1.13; 95% CI 1.09–1.18), children in single parent households exceeding 32.13% (OR 1.06; 95% CI 1.02–1.11), violent crime rate exceeding 250.54 per 100,000 (OR 1.07; 95% CI 1.03–1.12), diabetes exceeding 10.95% (OR 1.09: 95% CI 1.04–1.14), and drug poisoning deaths including opioids exceeding 14.17 per 100,000 (OR 1.04; 95% CI 1.01–1.08). Conclusion: When compared to an all-condition, hospitalized population, ocular hospitalizations tended to have small, yet statistically significant associations with health behaviors, socioeconomic, and physical environment factors. Further research will be needed on how the physical environment, social, and community variables affect ocular health relative to all-cause hospitalizations.
AB - Introduction: Social determinants of health (SDH) may influence inpatient utilization rates and outcomes but have yet to be associated with ocular diagnoses. The purpose of this paper was to determine whether the SDH are associated with ocular hospitalizations. Methods: Patients from the national Medicare 100% Inpatient Limited Dataset were examined and linked to SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Patients were included in the study group with either an admitting or primary diagnosis of an ophthalmic condition. All other hospitalized Medicare patients served in the comparison group. Nested logistic regression of these Medicare patients was conducted in their respective communities at the county level. SDH measures were benchmarked above or below the national median. Results: Positively associated SDH factors included communities with air pollution exceeding 11.62 micro grams per cubic meter (OR 1.05; 95% CI 1.01–1.08), communities where severe housing problems exceeding 14.38% (OR 1.13; 95% CI 1.09–1.18), children in single parent households exceeding 32.13% (OR 1.06; 95% CI 1.02–1.11), violent crime rate exceeding 250.54 per 100,000 (OR 1.07; 95% CI 1.03–1.12), diabetes exceeding 10.95% (OR 1.09: 95% CI 1.04–1.14), and drug poisoning deaths including opioids exceeding 14.17 per 100,000 (OR 1.04; 95% CI 1.01–1.08). Conclusion: When compared to an all-condition, hospitalized population, ocular hospitalizations tended to have small, yet statistically significant associations with health behaviors, socioeconomic, and physical environment factors. Further research will be needed on how the physical environment, social, and community variables affect ocular health relative to all-cause hospitalizations.
KW - Eye
KW - Hospitalization
KW - Social determinants of health
KW - Socioeconomic factors
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U2 - 10.1007/s40123-019-00220-1
DO - 10.1007/s40123-019-00220-1
M3 - Article
C2 - 31677061
AN - SCOPUS:85075118231
SN - 2193-8245
VL - 8
SP - 611
EP - 622
JO - Ophthalmology and Therapy
JF - Ophthalmology and Therapy
IS - 4
ER -
