{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:35:47Z","timestamp":1793450147953,"version":"4.5.0"},"reference-count":62,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec id=\"ab-soi240072-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Health care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240072-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240072-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240072-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Tract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240072-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2\u202f433\u202f603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1\u202f412\u202f968 female beneficiaries [58.1%]; 24\u202f165 Asian [1.0%], 158\u202f582 Black [6.5%], and 2\u202f182\u202f052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen\n                      <jats:italic>d<\/jats:italic>\n                      , 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi240072-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance\u2014stratifying surgical outcomes over a wider range\u2014than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.4195","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T11:36:08Z","timestamp":1727868968000},"page":"1404","source":"Crossref","is-referenced-by-count":38,"title":["Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes"],"prefix":"10.1001","volume":"159","author":[{"given":"Kimberly A.","family":"Rollings","sequence":"first","affiliation":[{"name":"Health & Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor"},{"name":"Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of 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