Observational studyJournal of general internal medicine2024
The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults.
Observational study in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The Association of an Electronic Frailty Index with Glaucoma Shunt Outcomes.Geriatrics (Basel, Switzerland) · 2026Article
- Does Modified 5-Item Frailty Index Correlate With Survival in Oropharyngeal Squamous Cell Carcinoma?Head & neck · 2026Article
- The association of area deprivation index and blood pressure control and therapeutic inertia among older adults with hypertension.Journal of human hypertension · 2025Article
- Neighborhood socioeconomic disadvantage is not associated with adverse outcomes following elective spine surgery in older Veterans.North American Spine Society journal · 2025Article
- Accountable care organizations and Medicare payments for residents with ADRD in disadvantaged neighborhoods.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- An Electronic Frailty Index Based on Deficit Accumulation May Predict Glaucomatous Visual Field Progression.Clinical ophthalmology (Auckland, N.Z.) · 2025Article
- Age does not improve the predictive ability of the Hospital Frailty Risk Score for length of stay.PloS one · 2025Article
- The Relationship of Frailty with Surgical and Laser Treatment for Patients with Glaucoma.Clinical ophthalmology (Auckland, N.Z.) · 2025Article
- Cross-sectional and longitudinal associations among healthcare costs and deficit accumulation.Journal of the American Geriatrics Society · 2024Article
- New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States.Age and ageing · 2024Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundRisk stratification and population management strategies are critical for providing effective and equitable care for the growing population of older adults in the USA. Both frailty and neighborhood disadvantage are constructs that independently identify populations with higher healthcare utilization and risk of adverse outcomes.
objectiveTo examine the joint association of these factors on acute healthcare utilization using two pragmatic measures based on structured data available in the electronic health record (EHR).
designIn this retrospective observational study, we used EHR data to identify patients aged ≥ 65 years at Atrium Health Wake Forest Baptist on January 1, 2019, who were attributed to affiliated Accountable Care Organizations. Frailty was categorized through an EHR-derived electronic Frailty Index (eFI), while neighborhood disadvantage was quantified through linkage to the area deprivation index (ADI). We used a recurrent time-to-event model within a Cox proportional hazards framework to examine the joint association of eFI and ADI categories with healthcare utilization comprising emergency visits, observation stays, and inpatient hospitalizations over one year of follow-up. KEY
resultsWe identified a cohort of 47,566 older adults (median age = 73, 60% female, 12% Black). There was an interaction between frailty and area disadvantage (P = 0.023). Each factor was associated with utilization across categories of the other. The magnitude of frailty's association was larger than living in a disadvantaged area. The highest-risk group comprised frail adults living in areas of high disadvantage (HR 3.23, 95% CI 2.99-3.49; P < 0.001). We observed additive effects between frailty and living in areas of mid- (RERI 0.29; 95% CI 0.13-0.45; P < 0.001) and high (RERI 0.62, 95% CI 0.41-0.83; P < 0.001) neighborhood disadvantage.
conclusionsConsidering both frailty and neighborhood disadvantage may assist healthcare organizations in effectively risk-stratifying vulnerable older adults and informing population management strategies. These constructs can be readily assessed at-scale using routinely collected structured EHR data.
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