ImportanceHealth care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood.ObjectiveTo compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures.Design, Setting, and ParticipantsThis cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023.Main Outcomes and MeasuresTract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics.ResultsA total of 2 433 603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1 412 968 female beneficiaries [58.1%]; 24 165 Asian [1.0%], 158 582 Black [6.5%], and 2 182 052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen d, 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts.Conclusions and RelevanceIn this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance—stratifying surgical outcomes over a wider range—than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.

中文翻译：

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使用 Medicare 受益人手术结果比较剥夺与脆弱性指数性能


重要性医疗保健研究人员、专业人员、支付方和政策制定者越来越依赖公开的地区级社会经济剥夺综合指数来解决健康公平问题。然而，索引选择的含义尚不清楚。目的使用政策相关结果比较 2 种常用剥夺指数在接受 3 种常见外科手术的 Medicare 受益人中的表现。设计、设置和参与者这项横断面研究检查了 2016 年至 2019 年间接受 3 种常见外科手术（髋关节置换术、膝关节置换术或冠状动脉旁路移植术）中 1 种的 Medicare 受益人（65 至 2019 岁）的结果。根据每个指数，对居住在高剥夺水平和低剥夺水平 （十分位数） 地区的受益人的指数鉴别表现进行了比较。分析是在 2022 年 12 月至 2023 年 8 月期间进行的。主要结果和措施使用 2020 年发布的区域剥夺指数 （ADI） 和社会脆弱性指数 （SVI） 实施了区域级剥夺。二元结局为计划外手术、 30 天再入院和 30 天死亡率。按每个指数分层的多变量 logistic 回归模型考虑了受益人和医院特征。结果共有 2 433 603 名医疗保险受益人（平均 [SD] 年龄，73.8 [6.1] 岁;1 412 968 名女性受益人 [58.1%];24 165 名亚洲人 [1.0%]，158 582 名黑人 [6.5%] 和 2 182 052 名白人 [89.7%]）被纳入分析。根据这两个指数，与居住在低贫困地区的受益人相比，居住在高贫困地区的受益人在所有手术的所有结果的调整后几率显著更高。 然而，与 ADI 相比，SVI 导致更高的调整比值比（调整后的比值比，SVI 为 1.17-1.31 vs ADI 为 1.09-1.23），显著更大的结果率差异（结果率差异，SVI 为 0.07%-5.17% 与结果率差异，ADI 为 0.05%-2.44%;95% CI 排除 0），以及居住在高贫困区与低贫困区的受益人的效应量更大（Cohen d，SVI 为 0.076-0.546 vs ADI 为 0.044-0.304）。结论和相关性在这项针对 Medicare 受益人的横断面研究中，SVI 在识别和区分高剥夺区和低剥夺区方面明显优于 ADI，根据常见外科手术的结果进行指数化。索引选择需要仔细考虑指数差异、指数表现和围绕使用的背景因素，尤其是在为资源分配和医疗保健支付调整模型提供信息以解决健康公平问题时。