The Application of Community-Based Information from the American Community Survey in a Large Integrated Health Care Organization.

Abstract

The American Community Survey (ACS) is the largest household survey conducted by the US Census Bureau. We sought to describe the community-level characteristics derived from the ACS among enrollees of Kaiser Permanente Southern California (KPSC), evaluate the associations between ACS estimates and selective individual-level health outcomes, and explore how using different scales of the census geography and the linearity assumption affect the associations. We examined the associations between track-level and block group-level ACS 5-year estimates and 4 individual-level Healthcare Effectiveness Data and Information Set (HEDIS) outcome measures (comprehensive diabetes care, postpartum care, antidepressant medication management, and childhood immunization status) using multilevel generalized linear models. Odds ratios and their 95% confidence intervals were estimated for every 10% increase in ACS measures. 6,357,841 addresses were successfully geocoded to at least the tract level. The community-level demographic, socioeconomic, residential, and other ACS measures varied among KPSC health plan enrollees. A majority of these ACS measures were associated with the selected HEDIS health outcomes. The directions of the effects were consistent across health outcomes; however, the magnitudes of the effect sizes varied. Within each HEDIS health outcome, the relative size of the effects appeared to remain similar. Differences between the census tract- and block group-level estimates were minor, especially for measures related to race/ethnicity, education, income, and occupation. These findings support the use of many ACS measures at neighborhood levels to predict health outcomes. The geographic units might have little effect on the results. The linearity assumption should be made with caution.