Article Figures & Data
Tables
- Table 1.
Average Census Tract Poverty, Low Education, and Composite Social Deprivation, by Practice Site Service Areas
Practice Code Number of Patients Percentage of Overall System Average Community Characteristics, by 100% Practice Service Area Poverty, % (SD) Low Education, % (SD) Social Deprivation Index (SD) 03 17,468 11.4% 15.9% (12.1) 10.6% (6.9) 28.5 (27.1) 07 5,742 3.8% 14.6% (8.9) 8.0% (5.2) 26.5 (20.4) 12 1,885 1.2% 14.3% (8.9) 8.1% (6.5) 27.5 (21.7) 10 24,618 16.1% 11.5% (9.8) 7.0% (7.2) 21.9 (20.5) 09 9,239 6.0% 11.4% (9.6) 6.8% (5.6) 20.4 (20.7) 06 13,191 8.6% 11.3% (9.9) 5.7% (6.4) 21.5 (21.8) 01 29,074 19.0% 11.3% (8.8) 5.7% (5.2) 19.0 (19.3) 02 21,174 13.9% 10.6% (7.7) 6.1% (5.7) 19.7 (18.4) 11 3,299 2.2% 9.4% (8.4) 5.0% (6.0) 16.2 (20.5) 08 7,843 5.1% 7.1% (6.9) 4.4% (4.1) 11.2 (14.3) 04 12,733 8.3% 6.8% (6.5) 4.2% (4.2) 11.8 (14.7) 05 6,696 4.4% 6.0% (6.3) 3.8% (3.8) 10.8 (13.5) Overall system 152,962 100.0% 11.0% (9.4) 6.4% (6.1) 19.9 (20.7) For practice-level service areas, we included census tracts, in Virginia, with at least 5 patients. Cold spots are defined as those census tracts in the highest quartiles for poverty, low education, and composite social deprivation. Poverty is measured by the percentage earning less than 200% of the federal poverty level. Low education measured by the percentage without a high school diploma or General Education Development. The Social Deprivation Index is a composite measure of community material and social deprivation and is a score from 0 to 100.
SD, standard deviation.
- Table 2.
Patients Living in Highest Poverty, Low Education, and Composite Social Deprivation Quartiles, by Practice
Practice Code Number and Percentage of Patients Living in Cold Spots Number of Patients in Poverty Cold Spots Percentage of Practice Number of Patients Low Education Cold Spots Percentage of Practice Number of Patients in Social Deprivation Index Cold Spots Percentage of Practice 03 5,082 29.1% 6,328 36.2% 5,645 32.3% 10 4,071 16.5% 4,308 17.5% 3,552 14.4% 12 294 15.6% 350 18.6% 338 17.9% 06 2,031 15.4% 1,761 13.4% 2,000 15.2% 09 1,346 14.6% 1,167 12.6% 1,278 13.8% 01 3,407 11.7% 2,639 9.1% 2,938 10.1% 07 652 11.4% 622 10.8% 1,270 22.1% 11 324 9.8% 345 10.5% 311 9.4% 02 1,488 7.0% 2,317 10.9% 2,065 9.8% 08 419 5.3% 332 4.2% 342 4.4% 04 367 2.9% 473 3.7% 580 4.6% 05 172 2.6% 201 3.0% 246 3.7% Overall system 19,653 12.8% 20,843 13.6% 20,565 13.4% For practice-level service areas, we included census tracts, in Virginia, with at least 5 patients. Cold spots are defined as those census tracts in the highest quartiles for poverty, low education, and composite social deprivation. Poverty is measured by the percentage earning less than 200% of the federal poverty level. Low education measured by the percentage without a high school diploma or General Education Development. The Social Deprivation Index is a composite measure of community material and social deprivation and is a score from 0 to 100.
Cold-Spot Designation Poverty Low Education Social Deprivation Index Percentage with the Chronic Condition or Receiving the Preventive Measure Cold Spot Noncold Spot Cold Spot Noncold Spot Cold Spot Noncold Spot Chronic conditions Obesity 34%* 28% 37%* 28% 35%* 28% Uncontrolled diabetes 14% 12% 15%* 13% 15%* 13% Preventive measures Prostate cancer 45%* 50% 45%* 50% 47% 49% Pneumonia vaccination 23% 23% 25%* 23% 23% 23% Colon cancer screening 30%* 32% 29%* 32% 30%* 32% Cervical cancer screening 16%* 15% 17%* 15% 17%* 15% Aspirin 44% 43% 44% 43% 44% 43% ↵* Percentages are significantly different (P < .05).
Cold spots are defined as those census tracts in the highest quartiles for poverty, low education, and composite social deprivation. Poverty is measured by the percentage earning less than 200% of the federal poverty level. Low education measured by the percentage without a high school diploma or General Education Development. The Social Deprivation Index is a composite measure of community material and social deprivation and is a score from 0 to 100.
Obesity was defined as those with a body mass index of 30 kg/m2 or more.
Uncontrolled diabetes was defined as those with a hemoglobin A1c of 9 or more.
We assessed pneumonia vaccination by determining whether those 65 years or older had one dose of the 23- or 13-valent pneumococcal vaccine, colorectal cancer screening by determining whether those aged 50 to 75 years had a colonoscopy within the past 10 years or a fecal occult blood test within the past year, cervical cancer screening by determining whether those aged 21 to 65 years had a pap smear within the past 3 years or those aged 30 to 65 years had a pap smear and human papilloma virus testing within the past 5 years, prostate cancer screening by whether men aged 55 to 70 years had a prostate-specific antigen performed within the past 2 years (excluding those with personal or family histories of prostate cancer, and African Americans), and aspirin use by determining whether those with a diagnosis of heart disease, congestive heart failure, or peripheral vascular disease had aspirin prescribed.
- Table 4.
Adjusted Odds Ratios for Quality of Chronic and Preventive Care by Cold Spot Designation
Cold Spot Designation Poverty Low Education Social Deprivation Index OR 95% CI OR 95% CI OR 95% CI Chronic conditions Obesity 1.33* 1.29–1.38 1.58*† 1.53–1.63 1.36* 1.31–1.41 Uncontrolled diabetes 1.06 0.89–1.26 1.16 0.98–1.38 1.12 0.93–1.35 Preventive measures Prostate cancer 0.8* 0.71–0.90 0.83* 0.73–0.92 0.91 0.79–1.03 Pneumonia vaccination 1.13*† 1.07–1.20 1.24*† 1.17–1.31 1.15*† 1.08–1.22 Colon cancer screening 0.88* 0.83–0.93 0.87* 0.82–0.92 0.89* 0.83–0.95 Cervical cancer screening 1.13* 1.07–1.19 1.17* 1.11–1.23 1.18* 1.11–1.24 Aspirin 1.13 0.92–1.38 1.18 0.97–1.44 1.18 0.95–1.47 CI, confidential interval; OR, odds ratio.
↵* ORs are significantly different from 1 (P < .05).
↵† The full multivariable model did not converge, so the practice random effect was excluded. Adjusted for age (estimates provided at age = 42.5 years), gender, race, and ethnicity. Cold spots are defined as those census tracts in the highest quartiles for poverty, low education, and composite social deprivation. Poverty is measured by the percentage earning less than 200% of the federal poverty level. Low education is measured by the percentage without a high school diploma or General Education Development. The Social Deprivation Index is a composite measure of community material and social deprivation and is a score from 0 to 100. Obesity was defined as those with a body mass index of 30 or more. Uncontrolled diabetes was defined as those with a hemoglobin A1c of 9 or more.
We assessed pneumonia vaccination by determining whether those 65 years or older had one dose of the 23- or 13-valent pneumococcal vaccine, colorectal cancer screening by determining whether those aged 50 to 75 year had a colonoscopy within the past 10 years or a fecal occult blood test within the past year, cervical cancer screening by determining whether those aged 21 to 65 had a pap smear within the past 3 years or those aged 30 to 65 had a pap smear human papilloma virus testing within the past 5 years, prostate cancer screening by whether men aged 55 to 70 had a prostate specific antigen performed within the past 2 years (excluding those with personal or family histories of prostate cancer, and African Americans), and aspirin use by determining whether those with a diagnosis of heart disease, congestive heart failure, or peripheral vascular disease had aspirin prescribed.
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