When context matters: social disparities in preventable hospitalizations among Medicare beneficiaries with dementia.

Background and Objectives: We examined geographic variation in the risk of potentially preventable hospitalization (PPH) among individuals with Alzheimer's disease and related dementias. Research Design and Methods: In this cross-sectional study, we analyzed a 20% random sample of 2017-2018 traditional Medicare claims ( Results: One-third of hospitalizations were PPHs. Urinary tract infection (33.8%), heart failure (25.7%), and pneumonia (18.6%) accounted for 78% of all PPHs. Unadjusted PPH rates were higher in highly disadvantaged areas (23.9%) compared to low-disadvantaged areas (20.6%). In the overall sample, Black and Hispanic individuals had higher odds of PPH than White individuals, as did those in highly disadvantaged areas compared to low-disadvantaged areas. Among highly disadvantaged urban and rural-or-micropolitan area residents, adjusted PPH rates were 23% and 27%, respectively. Odds of PPH were markedly higher in highly disadvantaged rural-or-micropolitan areas compared with low-disadvantaged areas. Racial/ethnic disparities diminished in these areas, while risk increased for female adults compared with male adults. Discussion and Implications: The highest PPH risk occurred in highly disadvantaged rural-or-micropolitan areas. Although racial/ethnic disparities were attenuated in these populations, the overall PPH risk was elevated. Policy efforts should prioritize expanding access to ambulatory care in disadvantaged areas.