Multimorbidity Burden for Adults Seeking Care in Community Health Centers Living in Different Areas of Social Deprivation

Abstract

<h3>Context:</h3> Neighborhood characteristics play an important role in health outcomes, especially for people who access care in community health centers (CHCs). <h3>Objective:</h3> This study evaluates rates of patient-level multimorbidity (≥2 chronic diseases) among CHC patients living in different areas of community-level social deprivation. <h3>Study Design and Analysis:</h3> Retrospective cohort study using Poisson mixed effects regression of the rates of morbidities by patient- and community-level characteristics including the social deprivation index (SDI). SDI is a composite measure of community-level income, education, employment, housing, household characteristics, transportation, and demographics. Morbidities included 22 chronic diseases recommended by the Department of Health and Human Services Multiple Chronic Conditions framework. <h3>Setting or Dataset:</h3> 1,412,038 patients from 9,362 Zip Code Tabulation Areas (ZCTAs) living in 27 states. <h3>Population Studied:</h3> Patients, ≥45 years from the OCHIN and HCN practice-based research networks. <h3>Intervention/Instrument:</h3> SDI (0-100) was categorized into quartiles using the patient’s ZCTA at last known address. Higher SDI quartiles denote more deprivation. <h3>Outcome Measures:</h3> Rates of morbidities at date of last known address. <h3>Results:</h3> Overall, patients averaged 2.50 morbidities (standard deviation [SD] = 2.20). Most patients were 45-54 years of age (38.2%), female (56.0%), non-Hispanic White (37.4%), spoke English (69.8%), continuously &lt;138% of the federal poverty line (FPL) (36.5%), and continuously insured (28.8%). In analytic models, patients in SDI quartiles 3 and 4 had a 7% and 10% higher rate of morbidities compared with SDI quartile 1. Older age groups had a higher rate of morbidities than 45-54 year age group (Incident Rate Ratio [IRR] 55-64: 1.26, IRR 65+: 1.48). Patients inconsistently over or under the 138% FPL threshold had a 10% higher rate of morbidities compared with those &lt;138% of the FPL (IRR = 1.10). Patients who were continuously or discontinuously insured experienced a 54% and 97% higher rate in morbidities (IRRs = 1.54 and 1.97), respectively, compared with continuously uninsured patients. <h3>Conclusions:</h3> Patients residing in more socially-deprived areas experienced a higher rate of morbidity burden than those in less socially-deprived areas. Community health centers should target preventive care interventions to avert further morbidity development among safety-net populations.