{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:25:48Z","timestamp":1785777948392,"version":"3.56.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"GEMSSTAR (Grants for Early Medical and Surgical Subspecialists\u2019 Transition to Aging Research) grant","award":["R03AG060177"],"award-info":[{"award-number":["R03AG060177"]}]},{"name":"The National Institute on Aging under the Paul B. Beeson Emerging Leaders Career Development Award in Aging","award":["K76AG068435"],"award-info":[{"award-number":["K76AG068435"]}]},{"name":"Orthopedic Research and Education Foundation Career Development Award"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Geriatr Orthop Surg Rehabil"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite advances in surgical care, disparities in functional recovery and mortality following hip fracture directly relate to racial, ethnic, and economic factors. Without a comprehensive method to model patients\u2019 diverse socioeconomic factors, researchers rely on proxies such as race and insurance status. The Distressed Community Index (DCI) score is a validated means of holistically estimating a patient\u2019s socioeconomic status, incorporating variables including community median income, unemployment, housing vacancies, education, business growth, and poverty rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The 2012-2014 100% Medicare Standard Analytical Files was queried, identifying patients surgically treated for isolated hip fractures. Individual socio-economic status was determined by linking residential ZIP codes with the DCI score. The study cohort was divided into 5 distinct tiers based on the DCI score: [0-20] (prosperous), [21-40] (comfortable), [41-60] (mid-tier), [61-80] (at risk), and &gt;80 (distressed). Multi-variate logistic regression analyses were used to assess the impact of increasing DCI score on 90-day complications, readmissions, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 364\u00a0074 patients met inclusion criteria. Patients with lower DCI scores were more likely to receive care at teaching hospitals (13.1%) in urban settings (97.6%) than the Distressed tier (8.7% and 73.6%, respectively). The distressed group was at a significantly higher risk of urinary tract infections (OR 1.12;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), pneumonia (OR 1.18;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and pressure ulcers (OR 1.09;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Patients in the distressed group were more likely to have emergency department visits (OR 1.12;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and had higher odds of mortality (OR 1.14;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). With elevated DCI score there were lower rates of readmission (OR 0.91-0.95;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) but this was not significant in the DCI &gt;80 group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients living in ZIP codes with high DCI score had higher risks of post-operative complications, including death, after hip fracture surgery. Integration of the DCI score into clinical practice may help to mitigate adverse outcomes in this vulnerable patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21514593251403427","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T08:12:13Z","timestamp":1766045533000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Elevated Distressed Community Index Score is Associated With Adverse Outcomes Following Hip Fracture Surgery in the Medicare Population"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4010-0500","authenticated-orcid":false,"given":"Mitchell T.","family":"Gray","sequence":"first","affiliation":[{"name":"University of Vermont Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice M.","family":"Bonsu","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeem Tariq","family":"Malik","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuan V.","family":"Ly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura S.","family":"Phieffer","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan K.","family":"Harrison","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safdar","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9945-7953","authenticated-orcid":false,"given":"Carmen E.","family":"Quatman","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center"},{"name":"Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1462"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-003-1385-4"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.97B3.34504"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.02.061"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.15.00676"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01329"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1519-x"},{"issue":"9","key":"e_1_3_6_9_2","first-page":"E95","article-title":"Total hip and total knee arthroplasties: trends and disparities revisited","volume":"39","author":"Bang H","year":"2010","unstructured":"Bang H, Chiu Y, Memtsoudis SG, et al. 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