Patients from the most disadvantaged neighborhoods spent nearly 23 fewer days at home during the year after a fall-related hip fracture, according to a cohort study published in JAMA Network Open.

Using claims-based days at home as a patient-centered measure, researchers evaluated postfracture recovery across neighborhood deprivation levels in older adults treated surgically for hip fracture. After adjustment for demographic, clinical, and health care system factors, patients in the most deprived neighborhoods spent 8.5% fewer days at home over 12 months compared with those in the least deprived areas, while patients in moderately deprived neighborhoods spent 5% fewer days at home. The findings suggest that neighborhood-level social risk may be relevant to discharge planning and postacute care decisions for older adults recovering from hip fracture.

Researchers analyzed Medicare fee-for-service claims and assessment data for beneficiaries aged 65 years or older who experienced a fall-related hip fracture between July 1, 2010, and December 31, 2019. Patients were included if they received operative treatment for a fall-related hip fracture and survived to discharge to the community or another postacute care setting. Patients residing in long-stay nursing facilities before fracture and those enrolled in Medicare Advantage were excluded. The final analytical cohort included 52,012 patients, with a mean age of 82.2 years; 74% were women.

Neighborhood socioeconomic context was assessed using the Area Deprivation Index, a census-based composite measure of neighborhood disadvantage incorporating 17 indicators related to income, education, employment, and housing. Patients were linked to the index using 9-digit zip codes at the time of fracture and categorized as living in the least deprived neighborhoods (10th percentile or lower), moderately deprived neighborhoods (11th to 89th percentile), or the most deprived neighborhoods (90th to 100th percentile). The primary outcome was days spent at home during the 12 months following hip fracture discharge, calculated as days alive minus days spent in hospitals, skilled nursing facilities, long-term care settings, inpatient rehabilitation, or emergency department observation.

Adjusted analyses accounted for age, sex, surgical type, comorbidity burden, prefracture days at home, and county-level hospital and nursing home capacity. Prefracture days at home were similar across deprivation categories, with a mean of approximately 175 days.

The researchers noted several limitations. Administrative claims data do not capture individual-level social factors, such as caregiver availability, transportation access, or social support, which may influence postfracture recovery. Exclusion of Medicare Advantage beneficiaries limits generalizability to a growing population of older adults. In addition, use of the Area Deprivation Index limited the ability to disentangle neighborhood-level effects from socioeconomic status, and exclusion of patients in areas without available deprivation data may have resulted in a healthier analytic sample.

“Future studies should seek to develop both immediate and long-term interventions to help patients overcome neighborhood barriers to high-quality aging in place after hip fracture,” noted lead author Alyssa M. Baginski, BS, of the University of Maryland School of Medicine, Baltimore, and colleagues.

The researchers reported no conflicts of interest.

Source: JAMA Network Open