Social Drivers of Health (SDoH) and Preventable Hospitalization Rates

In 2021, 13.6 percent of Black Californians’ hospital stays were potentially preventable, higher than any other racial/ethnic group’s and nearly twice as high as for California’s Asian/Pacific Islander patients (7.0 percent). Preventable hospitalizations reflect the level of access a population group may have to high-quality primary healthcare.

Why Publish Social Drivers of Health (SDoH) and Preventable Hospitalization Rates?#

Social drivers of health are conditions in the places where people live, learn, work, and play that affect a person’s quality of life and health outcomes. These conditions may include socioeconomic, lifestyle and environmental factors and access to health care.

The following analysis focuses on the relationship between preventable hospitalizations and patient race/ethnicity in combination with six social drivers of health. Race/ethnicity has been identified as an important health equity factor because patients with different race/ethnicities experience different health outcomes.

Preventable hospitalizations are used to gauge patients’ access to high-quality primary healthcare. Preventable hospitalizations provide a method of assessing the ability of the healthcare system to avoid medical complications through high-quality preventive care provided in the community. Groups of patients with more preventable hospitalizations (as a percent of all hospital discharges) typically have less access to quality primary healthcare.

Hospitalization Rates by Race/Ethnicity and Social Driver of Health#

Six social drivers of health (SDoH) are examined in the analyses shown on this page:

• Preferred Language Spoken: The language a person primarily uses when communicating with those in the healthcare community. This is measured at the encounter level.
• Expected Payer: The type of entity or organization expected to pay the greatest share of the person’s medical bill. This is measured at the encounter level.
• Employment Rate: Percent of people aged 20-64 with a job. This is measured at the ZIP code level.
• Home Ownership Rate: Percent of people who own their home. This is measured at the ZIP code level.
• Rate of Park Access: Percent of people living within walkable distance (half-mile) of a park, beach, or open space. This is measured at the ZIP code level.
• Homes with Basic Kitchen Facilities: Percent of households with basic kitchen facilities and plumbing. This is measured at the ZIP code level.

To better understand the relationship between preventable hospitalizations rates and the interplay of SDoH and race/ethnicity, hospitalizations have been categorized by both social drivers and patient race/ethnicity categories. Some of the social drivers have standard categories (e.g., payer or language), while others (e.g., employment rate) were split into three levels (i.e., bottom third, middle third and top third) of approximately equal size. The “bottom third” level indicates the grouping of ZIP codes with the lowest rate of employment, home ownership, park access or basic kitchen facilities.

Key Findings#

• Looking at race/ethnic groups and language groups that had at least 1000 hospitalizations, Black Californians who preferred to speak English in a healthcare setting experienced the highest rate of preventable hospitalizations (13.7 percent), representing 32,180 hospitalizations statewide. This rate was followed closely by White patients who preferred to speak a language other than English or Spanish (11.7 percent), accounting for 2,460 hospitalizations.
• Statewide, Asian/Pacific Islanders, American Indian or Alaska Natives, and Whites who preferred to speak a language other than English or Spanish in a healthcare setting had higher rates of preventable hospitalizations than their counterparts who speak English or Spanish in healthcare settings.
• Statewide, Hispanics who preferred to speak a language other than English in healthcare settings had a higher rate of preventable hospitalizations than their English-proficient counterparts.
• Across race/ethnic groups, Medi-Cal beneficiaries had higher rates of preventable hospitalizations when compared to patients with private insurance as their expected payer. It is likely that Medi-Cal beneficiaries disproportionately experience other SDoH-related adverse factors or barriers, such as more limited access to transportation, when compared to patients who have private insurance coverage.
• Asian/Pacific Islander patients with Medi-Cal as their expected payer had over three times the statewide rate of preventable hospitalizations (8.0 percent) compared to Asian/Pacific Islander patients with private insurance as their expected payer (2.6 percent).
• Across race/ethnic groups, the areas with highest levels of employment had fewer preventable hospitalizations than those areas with the lowest levels of employment. The same pattern is observed when comparing the areas with the highest levels of home ownership to the areas with the lowest levels.
• The Black preventable hospitalization rate in areas with the highest employment rates (11.7 percent) was higher than rates experienced by any other race/ethnic group in areas with the lowest employment rates (8.3-10.6 percent). The same pattern is observed for the other three social drivers of health that were examined: home ownership, access to parks and basic kitchen facilities.

Note: Each tab focuses on a different intersection between race/ethnicity, a social driver of health and preventable hospitalizations. Social drivers of health were measured by creating patient groupings based on their preferred language spoken, expected payer type, employment rate, home ownership rate, rate of park access and homes with basic kitchen facilities.

Note: Each tab focuses on a different intersection between either race/ethnicity or a social driver of health and preventable hospitalizations over time. Patient groupings were created based on their race/ethnicity, expected payer type and preferred language spoken. Four social drivers were excluded from this visualization because data for these were not available for multiple years.

How HCAI Created This Product#

• Preventable hospitalizations rates were created by dividing the number of hospitalizations for patients who are 18 years or older and were for at least one of the preventable hospitalization diagnoses (see list below) by the total number of hospitalizations for individuals aged 18 or older.
• The analyses on this page follow the California Health and Human Services Agency’s Data De-Identification Guidelines. Data from any group with less than 11 individuals are labeled and numerator groups with less than 100 were also labeled. In addition, groups are rounded to the tens place value. All percentages reflect these changes, not the original number of encounters.
• Preventable hospitalization diagnoses: diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, angina without a cardiac procedure, dehydration, bacterial pneumonia, or urinary tract infection were counted as a preventable hospitalization. These conditions correspond with those used by the Agency for Healthcare Research and Quality (AHRQ) to calculate the Prevention Quality Indicator – Overall Composite Measure (PQI #90).
• Four SDoH indicators (2015 Employment Rate, 2015 Home Ownership Rate, 2017 Rate of Park Access, 2013 Homes with Basic Kitchen Facilities), stratified into ZIP Codes, were downloaded from the Healthy Places Index (https://www.healthyplacesindex.org/) and divided into three nearly equal groups (bottom third, middle third and top third). These three groupings of ZIP codes were then used to assign discharges into one the groupings, based on each patient’s residential ZIP code. The percentages of preventable hospitalizations were then calculated based on those groupings.

Additional Information#

Topic: Healthcare Quality
Source Link: AHRQ Quality Indicators, Healthy Places Index
Citation: HCAI – Patient Discharge Data, Prevention Quality Indicators, 2017-2021
Temporal Coverage: 2017-2021
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually
Related Resources: To learn more about HCAIs various social impact programs and data products please visit the HCAI Social Impact webpage.