ArticleGeriatric orthopaedic surgery & rehabilitation2025
Elevated Distressed Community Index Score is Associated With Adverse Outcomes Following Hip Fracture Surgery in the Medicare Population.
Article in Geriatric orthopaedic surgery & rehabilitation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite advances in surgical care, disparities in functional recovery and mortality following hip fracture directly relate to racial, ethnic, and economic factors. Without a comprehensive method to model patients' diverse socioeconomic factors, researchers rely on proxies such as race and insurance status. The Distressed Community Index (DCI) score is a validated means of holistically estimating a patient's socioeconomic status, incorporating variables including community median income, unemployment, housing vacancies, education, business growth, and poverty rates. Methods: The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and >80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality. Results: A total of 364 074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12; Conclusions: Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.
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