Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states. Issue 11 (27th November 2019)

• Record Type: Journal Article
• Authors: Roy, Brita; Riley, Carley; Herrin, Jeph; Spatz, Erica; Hamar, Brent; Kell, Kenneth P; Rula, Elizabeth Y; Krumholz, Harlan
• Is Part Of: BMJ open. Volume 9:Issue 11(2019)
• Publication Date: 2019-11-27
• Subjects: hospitalisation rates -- preventive medicine -- healthcare utilisation -- well-being -- population health -- community health; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-030017
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates. Design: Cross-sectional study Setting: Zip codes within six US states (Florida, Iowa, Nebraska, New York, Pennsylvania and Utah) Main outcome measures: Our primary outcome was age-adjusted, all-cause hospitalisation rates in 2010; secondary outcomes included potentially preventable disease-specific hospitalisation rates, including cardiovascular-related, respiratory-related and cancer-related admissions. Our main independent variable was the Gallup-Sharecare Well-Being Index (WBI) and its domains (life evaluation, emotional health, work environment, physical health, healthy behaviours and basic access). Results: Zip codes with the highest quintile of well-being had 223 fewer hospitalisations per 100 000 (100k) residents than zip codes with the lowest well-being. In our final model, adjusted for WBI respondent age, sex, race/ethnicity and income, and zip code number of hospital beds, primary care physician density, hospital density and admission rates for two low-variation conditions, a 1 SD increase in WBI was associated with 5 fewer admissions/100k (95% CI 4.0 to 5.8; p<0.001). Results were similar for cardiovascular-related and respiratory-related admissions, but no association remained for cancer-related hospitalisation after adjustment. Patterns were similar for each of the WBI domains and all-cause hospitalisations. Conclusion and relevance: Community well-being is inversely associated with local hospitalisation rates. In addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.