Census Tract Variability in COPD Emergency Department, Hospitalization, and Readmission Rates in Travis County, Texas.

Rationale: The variation of chronic obstructive pulmonary disease (COPD) population-level exacerbation rates at fine spatial scales is unclear but is important for understanding the potential role of neighborhood-level factors in risk for COPD exacerbations. We aim to describe the spatial distribution of emergency department (ED) visits, hospitalizations, and readmissions for acute exacerbations of COPD (AECOPDs) across census tracts in Travis County, Texas, and understand the neighborhood characteristics that may contribute to census tract-level morbidity. Methods: We used the Texas Health Care Information Collection data set and the U.S. Census Bureau’s 2019 American Community Survey to calculate census tract-specific population-based incidence rates (PBIRs) and readmission rates from January 2016 through December 2020. Conditional autoregressive models were used to map estimated PBIRs of acute care use outcomes across census tracts. We then examined associations of neighborhood characteristics with census tract-level rates of acute care use. Results: Census tract-level incidence rates of COPD-related ED visits and hospital admissions exhibited spatial patterning across Travis County. In contrast, there was less spatial patterning of census tract-level readmission rates across census tracts. Several census tract demographic, socioeconomic, and built environment characteristics were associated with census tract-level COPD-related ED visit and hospitalization rates, but not with COPD readmission rates. Conclusion: There is a spatial pattern of ED visit and hospitalization PBIRs for AECOPDs within Travis County and several associations with neighborhood characteristics. Readmission rates did not exhibit clear spatial patterning across census tracts and did not have similar associations with neighborhood characteristics.