Association of Area‐Level Heat and Social Vulnerability With Recurrent Hospitalizations Among Individuals With Rheumatic Conditions

Abstract

Objective Climate and social vulnerability contribute to morbidity and health care utilization. We examined associations between the neighborhood Social Vulnerability Index (SVI) and the Heat Vulnerability Index (HVI) and recurrent hospitalizations among individuals with rheumatic conditions. Methods Using a Massachusetts multihospital centralized clinical data repository, we identified individuals ≥18 years of age with a rheumatic condition who received rheumatology care within 3 years of April 2021. We defined the index date as 2 years before the last encounter and the baseline period as 1 year pre‐index date. Addresses were geocoded and linked by census tract to the SVI and the HVI. We used multilevel, multinomial logistic regression to examine the odds of 1–3 and ≥4 hospitalizations (reference = 0) over 2 years post index date by vulnerability index, adjusting for age, gender, race/ethnicity, insurance, and comorbidities. Results Among 14,401 individuals with rheumatic conditions, the mean ± age was 61.9 ± 15.7 years, 70% were female, 79% White, 7% Black, and 2% Hispanic. There were 8,251 hospitalizations; 11,649 individuals (81%) had 0 hospitalizations, 2,063 (14%) had 1–3, and 689 (5%) had ≥4. Adjusting for individual‐level factors, individuals living in the highest versus lowest SVI areas had 1.84 times higher odds (95% confidence interval [95% CI] 1.43–2.36) of ≥4 hospitalizations. Individuals living in the highest versus lowest HVI areas had 1.64 times greater odds (95% CI 1.17–2.31) of ≥4 hospitalizations. Conclusion Individuals with rheumatic conditions living in areas with high versus low social and heat vulnerability had significantly greater odds of recurrent hospitalizations. Studies are needed to determine modifiable factors to mitigate risks.

Social Determinants of Health Documentation Among Individuals With Rheumatic and Musculoskeletal Conditions in an Integrated Care Management Program

“…Limitations of this study include lack of data outside of our population cohort, as we have only analyzed individuals enrolled in the iCMP program who may be more likely to both have higher prevalence and documentation of SDoH‐related needs compared to a less complex population. Compared to a prior study in individuals receiving rheumatic disease care within our multihospital system (6), this population, on average, was about 10 years older, had a similar gender and race distribution, and had a higher percentage of Hispanic individuals and Medicare beneficiaries. As iCMP only requires the primary care physician to be within the multihospital system and not the subspecialists, there may be misclassification of rheumatic/musculoskeletal conditions.…”

“…A study of patients with systemic lupus erythematous (SLE) showed that moving out of poverty led to lower mean scores of newly accumulated disease damage, similar to scores of participants who were never in poverty (5). Across rheumatic conditions, living in areas of high heat or social vulnerability has been associated with higher odds of recurrent hospitalizations (6).…”