Hearing Loss and Preventable Hospitalizations

Nearly half of all adults over the age of 60 years have hearing loss. Recent research suggests adults with hearing loss experience increased health care expenditures and hospitalization. However, little is known about whether these are preventable hospitalizations which may indicate poorer healthcare system engagement. In this cross-sectional analysis, we examined data from combined 2016-2018 Medicare Current Beneficiary Survey (MCBS) datasets. Participants are asked to describe their self-perceived trouble hearing. Preventable hospitalizations were defined and generated from administrative claims files based on the Agency for Healthcare Research and Quality identified conditions that should be manageable in ambulatory care settings. Multivariate regression models adjusted for demographic/socioeconomic characteristics and general health determinants were used to explore the association between trouble hearing and outcomes. The combined 2016-2018 MCBS administrative claims files included 18,814 participant-years, 49.8% reported no trouble hearing, 43.4% reported a little trouble and 6.8% a lot of trouble hearing, respectively. A higher proportion of those with a lot of trouble hearing (6.8%) experienced at least one preventable hospitalization compared to those with a little trouble hearing (3.4%) and no trouble hearing (2.5%). In a fully adjusted logistic regression model, hearing loss was associated with 1.35 times the odds of experiencing at least one preventable hospitalization per year (OR=1.35; 95% CI=1.03-1.77). Medicare beneficiaries with hearing loss experience higher rates of preventable hospitalizations. This may be due to avoidance of care due to communication barriers. Further work is needed to understand underlying reasons and whether addressing hearing loss modifies the observed association.

Preventable Hospitalizations in Adults With Alzheimer's Disease and Related Dementias: United States, 2016–2018

Alzheimer's disease and related dementias (ADRD) are a significant public health burden. Preventing hospitalizations in adults with ADRD is a public health priority. Data from the 2016–2018 Healthcare Cost Utilization Project National Inpatient Sample, an all-payer representative sample of US hospitalizations, were used to describe potentially preventable hospitalizations in adults ≥45 years with ADRD using International Classification of Disease, Tenth Edition, Clinical Modification (ICD-10-CM) codes. Definitions for principal or any-listed ICD-10-CM codes from the Agency for Healthcare Research and Quality defined potentially preventable hospitalizations where admissions might have been avoided by appropriate outpatient primary care management. Of discharges in adults ≥45 years with a potentially preventable hospitalization diagnosis, 11.4% (N=389,155) had a diagnosis of ADRD listed in any position. Of those discharges with ADRD, a significantly higher proportion (82.6%) with diagnosis related to potentially preventable hospitalizations were aged ≥75 years compared to 78.9% without potentially preventable hospitalizations. Additionally, of those with ADRD and potentially preventable hospitalization diagnoses, a higher proportion died in the hospital (5.7%) compared to those without potentially preventable hospitalization diagnoses (3.4%). The most common potentially preventable hospitalization diagnoses among adults with ADRD were related to sepsis (34.0%), injuries (20.8%), urinary tract infections (14.2%), and heart failure (12.7%). Measures focusing on preventing injuries as well as identifying early signs and symptoms of potentially preventable hospitalizations like urinary tract infections and sepsis in adults with ADRD could reduce the number of preventable hospitalizations in this population.

Abstract P178: Social Determinants Of Health And Preventable Hospitalization For Hypertension

Introduction: Social determinants of health (SDH) can have a significant impact on the risk of hypertension related hospitalization. Understanding the drivers of potentially preventable hospitalizations for hypertension improves health outcomes and reduce associated costs. Identifying place and associated SDH has implications for tailored interventions to address disparities for high burden population for preventable hypertension hospitalization as hypertension and associated cardiovascular disease. Methods: County level preventable hospitalization rates for hypertension for Virginia was obtained using prevention quality indicators published by the Agency for Healthcare Research and Quality. The Health Opportunity Index (HOI), developed by the Virginia Department of Health to identify vulnerable populations is a multivariate tool that uses complex SDH indicators of a community and comprises of 13 indices - affordability, income inequality, Townsend/Material deprivation, job participation, employment access, education, air quality, segregation, food accessibility, population density, population churning, walkability, and access to care. Principal component analysis was used to develop the composite HOI and further aggregated into simple quintiles at the county level. Step-wise multiple regression analysis was performed to explore SDH and preventable hospitalization for hypertension. Results: Material deprivation index ( r = -.44), affordability index ( r = -.42) and air quality index ( r = -.23) were found to be significantly associated with preventable hospitalization rate for hypertension. Together the model accounted for 23% of the variability in the preventable hypertension hospitalization rate ( p > 0.05). Conclusions: Findings indicate that neighborhoods that spend most on housing and transportation and that are materially deprived of goods, services, amenities and resources and physical environment have higher rates of preventable hospitalization for hypertension. Areas with higher air pollution may result in hypertension. Addressing these disparities by targeted approach is one possible approach to reducing the burden of preventable hospitalization for hypertension in Virginia.

Social Determinants of Diabetes-Related Preventable Hospitalization in Taiwan: A Spatial Analysis

Diabetes-Related Preventable Hospitalization (DRPH) has been identified as an important indicator of efficiency and quality of the health system and can be modified by social determinants. However, the spatial disparities, clustering, and relationships between DRPH and social determinants have rarely been investigated. Accordingly, this study examined the association of DRPH with area deprivation, densities of certificated diabetes health-promoting clinics (DHPC) and hospitals (DHPH), and the presence of elderly social services (ESS) using both statistical and spatial analyses. Data were obtained from the 2010–2016 National Health Insurance Research Database (NHIRD) and government open data. Township-level ordinary least squares (OSL) and geographically weighted regression (GWR) were conducted. DRPH rates were found to be negatively associated with densities of DHPC (β = −66.36, p = 0.029; 40.3% of all townships) and ESS (β = −1.85, p = 0.027; 28.4% of all townships) but positively associated with area deprivation (β = 2.96, p = 0.002; 25.6% of all townships) in both OLS and GWR models. Significant relationships were found in varying areas in the GWR model. DRPH rates are high in townships of Taiwan that have lower DHPC densities, lower ESS densities, and greater socioeconomic deprivation. Spatial analysis could identify areas of concern for potential intervention.