Hospital Area Deprivation Index and Cohort Characteristics in New York State

The objective was to examine whether there is concordance between a hospital’s neighborhood area deprivation index (ADI) and hospital cohort social risk. We summarized 2021 inpatient discharges for 203 New York state hospitals from the Statewide Planning and Research Cooperative System. The primary independent variable was hospital Medicaid payor mix, classified into five quintiles defined by increasing Medicaid levels, a proxy for hospital cohort social risk. The outcome was national ADI rank associated with the hospital 12-digit FIPS code, representing neighborhood socioeconomic status. Seventy-four (37%) hospitals were classified as high Medicaid hospitals each serving up to 20,000 Medicaid-covered patients. ADI-identified neighborhood disadvantage decreased as hospital Medicaid proportion increased (ADI score = −4.61, p < 0.001). The discordancy rate was 23%–40 hospitals treating increasing proportions of disadvantaged patients are in areas classified as advantaged by the ADI. Hospitals identified as highly discordant were concentrated at the extremes of hospital Medicaid payer mix. If ADI is used to identify high social risk areas, careful calibration is recommended, especially in dense urban areas, where ADI may misclassify hospitals, potentially leading to inadequate resource allocation. Including cohort-level characteristics may improve the ability of ADI to identify high social risk hospitals and patients.