Neighborhood Socioeconomic Disadvantage and Acute Care Utilization in Washington State Medicaid: A Retrospective Cohort Study

Abstract

Background: Neighborhood disadvantage has been associated with potentially preventable acute care utilization among Medicare beneficiaries but this association has not been studied in a Medicaid population, which is important for informing more equitable care and policies for this population.Methods: We conducted a retrospective cohort study of 100% Medicaid claims for 1.5 million unique adult beneficiaries enrolled for at least 11 months of a calendar year during the period 2017-2021. Mixed effects logistic regression was applied to estimate the association between state-level ADI decile and Emergency Department (ED) visits, low acuity ED visits, and hospitalizations in a calendar year, adjusting for patient characteristics. Standard errors were clustered at the Census block group level. Results: Increasing levels of neighborhood socioeconomic disadvantage (by ADI decile) were associated with greater odds of any ED visits (adjusted OR 1.07, 1.06-1.07), low acuity ED visits (1.08, 1.08-1.08), and any hospitalizations (1.02, 1.02-1.02). Conclusions: Among Medicaid beneficiaries, greater neighborhood socioeconomic disadvantage was associated with increased acute care utilization, including potentially preventable ED visits. These findings signal potential barriers to outpatient care access that could be amenable to future interventions by health systems and payers.