A Johns Hopkins Bloomberg School of Public Health study suggests nearly 80% hospitals admit a significantly different proportion of Black Medicare patients age 65 and older compared to those admitted to any hospital in that market — which could point to racial sorting.
The study, published April 19 in JAMA Network Open, analyzed more than 4.8 million patients from a sample of 1,991 hospitals across the U.S. during 2019. The researchers developed a measure called Local Hospital Segregation index, which takes the percentage of a racial group in a given hospital's admissions and subtracts the percentage of that race in all hospital admissions in the surrounding area — defined as ZIP codes within 30 minutes of driving time. The first-of-its-kind metric measures hospital segregation in hospital admissions in their markets, an April 23 news release from Baltimore-based Johns Hopkins said.
Here are three findings:
- Half of hospitalizations among Black Medicare patients happened in 235, or 11.8%, of hospitals in the sample.
- A total of 878 hospitals, or 34.4%, earned a negative Local Hospital Segregation score while 1,113 hospitals exhibited a positive score, meaning they admitted more Black patients relative to their local hospital market.
- A racial sorting effect was particularly common in areas with large concentrations of Black residents.
"While U.S. hospitals are prohibited from discriminating against patients on the basis of race, some hospitals end up with disproportionately fewer or greater Black patients that live in the relative area," the news release said. "This differential sorting may help explain persistent inequities in access to quality healthcare."