A spatial analysis of race, local health-promoting resources and preventable hospitalizations

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Introduction Preventable hospitalizations (PHs) for chronic conditions could have been avoided if treated with primary healthcare. PH rates are higher among African Americans, and in areas with less healthcare. Little is known about the effects of non-healthcare local health-promoting resources (LHPRs). The objective of this study is to determine associations between LHPRs and chronic PH rates in Maryland, and to assess spatial clustering of areas with high PH rates. Methods Hospitalizations in 2010 were obtained from the Maryland Health Services Cost Review Commission by zip code of residence. Negative binomial regressions were used to determine associations between PH rates and LHPRs by race. Clusters of zip codes with high PH rates were assessed using the spatial Scan Statistic. Results PH rates were associated with family practitioners (IRR = 0.98, 95% CI = 0.97–0.99), physicians' assistants (IRR = 0.98, 95% CI = 0.96–0.99), internists (IRR = 1.02, 95% CI = 1.01–1.03), teaching hospitals (IRR = 1.21, 95% CI = 1.04–1.40), and local health departments (IRR = 1.19, 95% CI = 1.03–1.37). No LHPRs were associated with PHs among whites, but African American PH rates were associated with family practitioners (IRR = 0.97, 95% CI = 0.94–0.99), nurse practitioners (IRR = 1.03, 95% CI = 1.01–1.06), teaching hospitals (IRR = 1.37, 95% CI = 1.08–1.75) and gyms/recreational centers (IRR = 0.85, 95% CI = 0.73–0.99). Clusters of areas with high PH rates varied by race. African American PH clusters had fewer family practitioners and more federally qualified health centers and teaching hospitals. Conclusions Public health practitioners should look to LHPRs beyond physician supply or public clinics to address PHs, particularly among African Americans. Specific LHPRs could be used to target African American PH rates and clusters.

Original languageEnglish (US)
Pages (from-to)149-155
Number of pages7
JournalPreventive Medicine
StatePublished - Dec 1 2017


  • African Americans
  • Hospitalization
  • Residence characteristics

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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