{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:12:48Z","timestamp":1765609968458,"version":"3.48.0"},"reference-count":67,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K12 HS023000"],"award-info":[{"award-number":["K12 HS023000"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,11,7]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Zip codes within six US states (Florida, Iowa, Nebraska, New York, Pennsylvania and Utah)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Our primary outcome was age-adjusted, all-cause hospitalisation rates in 2010; secondary outcomes included potentially preventable disease-specific hospitalisation rates, including cardiovascular-related, respiratory-related and cancer-related admissions. Our main independent variable was the Gallup-Sharecare Well-Being Index (WBI) and its domains (life evaluation, emotional health, work environment, physical health, healthy behaviours and basic access).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Zip codes with the highest quintile of well-being had 223 fewer hospitalisations per 100\u2009000 (100k) residents than zip codes with the lowest well-being. In our final model, adjusted for WBI respondent age, sex, race\/ethnicity and income, and zip code number of hospital beds, primary care physician density, hospital density and admission rates for two low-variation conditions, a 1 SD increase in WBI was associated with 5 fewer admissions\/100k (95% CI 4.0 to 5.8; p&lt;0.001). Results were similar for cardiovascular-related and respiratory-related admissions, but no association remained for cancer-related hospitalisation after adjustment. Patterns were similar for each of the WBI domains and all-cause hospitalisations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and relevance<\/jats:title>\n                    <jats:p>Community well-being is inversely associated with local hospitalisation rates. In addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030017","type":"journal-article","created":{"date-parts":[[2019,11,28]],"date-time":"2019-11-28T05:15:28Z","timestamp":1574918128000},"page":"e030017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3782-0104","authenticated-orcid":false,"given":"Brita","family":"Roy","sequence":"first","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carley","family":"Riley","sequence":"additional","affiliation":[{"name":"Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeph","family":"Herrin","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-7713","authenticated-orcid":false,"given":"Erica","family":"Spatz","sequence":"additional","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Hamar","sequence":"additional","affiliation":[{"name":"Sharecare Inc, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth P","family":"Kell","sequence":"additional","affiliation":[{"name":"Tivity Health, Nashville, Tennessee, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth Y","family":"Rula","sequence":"additional","affiliation":[{"name":"Tivity Health, Franklin, Tennessee, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-127X","authenticated-orcid":false,"given":"Harlan","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA"},{"name":"Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,27]]},"reference":[{"key":"2025121221194628000_9.11.e030017.1","unstructured":"Catlin B , Jovaag A , Givens M , et al . 2016 County health rankings: key findings report. 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