Observational studyJournal of the American Medical Directors Association2025
Disparities in Infection Risk Among Home Health Care Patients: A Study Using Area Deprivation Index.
Observational study in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Risk factors for polymicrobial klebsiella pneumoniae bloodstream infection: a retrospective cohort study using the antimicrobial resistance monitoring database.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Infection prevention and control knowledge, attitudes, and practices among home health care patients and their family caregivers: Findings from a multisite survey.American journal of infection control · 2026Article
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11 authors.
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Abstract
objectiveTo examine the association between neighborhood deprivation and infection-related hospitalizations among home health care (HHC) patients across different rurality levels.
designRetrospective observation analysis of 2019 national data sets, including Medicare data linked to 2019 Area Deprivation Index (ADI) data and Rural-Urban Continuum Codes (RUCCs). SETTING AND
participantsThe sample includes 3,656,810 HHC patients from 8135 HHC agencies nationwide. Patients were predominantly White (77.6%), with an average age of 80 years, and mostly female (61.7%). The sample included 24% dual-eligible patients and those living in large metropolitan (53.8%), small metro (30.2%), rural adjacent (11.4%), and remote rural areas (4.6%).
methodsHospital admissions due to infection were identified through International Classification of Diseases, Tenth Revision (ICD-10), codes. Neighborhood deprivation was measured by the 2019 ADI. Patients were stratified by RUCC (large metro, small metro, rural adjacent, or remote rural). Within each rurality stratum, ADI quartiles were constructed, with higher quartiles indicating greater neighborhood deprivation. Multivariable logistic regression was conducted, adjusting for multiple-level variables.
resultsAs neighborhood deprivation increased, there was a rise in the proportion of dual-eligible, female, Black, and Hispanic patients, whereas the proportion of White patients decreased, especially in rural areas. Rural areas with higher ADI rankings showed lower quality metrics and reduced health care resources. Higher ADI quartiles were significantly associated with increased infection risks after adjusting for covariates, but this was only observed in remote rural areas, not in urban areas. CONCLUSIONS AND IMPLICATIONS: The findings highlight significant policy and clinical implications for remote rural areas. Policymakers should increase investments in rural health infrastructure, enhance telehealth, improve transportation services, and offer incentives for health care providers to practice in these areas. The nonsignificant association between neighborhood deprivation and infection outcomes in metropolitan areas may stem from the ADI's limited sensitivity to urban contexts, highlighting the need for more nuanced indices that better capture urban socioeconomic challenges.
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