Table 1. County Characteristics by Geographic Price-Adjusted per Beneficiary Medicare Spending Quintilesa.
| Characteristic | Mean (SD) | Difference between quintiles 5 and 1 (95% CI) | P value | |||||
|---|---|---|---|---|---|---|---|---|
| Total (n = 3038) | Price-adjusted per beneficiary Medicare spending quintiles | |||||||
| 1 (n = 608) | 2 (n = 608) | 3 (n = 607) | 4 (n = 608) | 5 (n = 607) | ||||
| Medicare cost, $ | ||||||||
| Price-adjusted per beneficiary spending, range | 4447-16 570 | 4447-8308 | 8311-9109 | 9111-9799 | 9802-10 578 | 10 579-16 570 | NA | NA |
| Price-adjusted per beneficiary spending | 9784 (1328) | 7679 (522) | 8763 (214) | 9463 (183) | 10 179 (216) | 11 464 (735) | 3785 (3706 to 3862) | <.001 |
| Demographic characteristics | ||||||||
| Age, y | 71.6 (1.5) | 71.6 (1.3) | 71.4 (1.5) | 71.4 (1.4) | 71.5 (1.6) | 71.8 (1.5) | 0.17 (−0.01 to 0.34) | .049 |
| Women, % | 54.8 (1.8) | 53.2 (1.8) | 54.2 (1.8) | 54.8 (1.6) | 55.3 (1.7) | 55.5 (1.5) | 2.29 (2.10 to 2.48) | <.001 |
| Clinical risk | ||||||||
| CMS-HCC score | 1.0 (0.1) | 0.9 (0.1) | 0.9 (0.1) | 1.0 (0.1) | 1.0 (0.1) | 1.1 (0.1) | 0.22 (0.21 to 0.23) | <.001 |
| Supply of health resources per 1000 population, No. | ||||||||
| PCPs | 0.8 (0.3) | 0.9 (0.3) | 0.7 (0.4) | 0.7 (0.3) | 0.8 (0.3) | 0.7 (0.2) | −0.18 (−0.21 to −0.15) | <.001 |
| Specialists | 2.0 (1.5) | 2.0 (1.7) | 1.5 (1.3) | 1.8 (1.5) | 2.3 (1.9) | 2.0 (1.2) | 0.04 (−0.12 to 0.21) | .61 |
| Hospital beds | 2.5 (2.1) | 2.0 (1.9) | 2.2 (2.1) | 2.3 (2.3) | 2.8 (1.9) | 2.8 (2.1) | 0.82 (0.57 to 1.06) | <.001 |
| SNF beds | 5.0 (3.0) | 3.7 (2.7) | 5.2 (3.2) | 5.1 (3.1) | 5.6 (3.0) | 5.1 (2.7) | 1.31 (0.99 to 1.64) | <.001 |
| HHA aides | 0.5 (1.4) | 0.2 (0.3) | 0.5 (2.7) | 0.4 (0.7) | 0.8 (1.7) | 0.4 (0.6) | 0.24 (0.18 to 0.30) | <.001 |
| Hospice RNs | 0.18 (0.17) | 0.15 (0.13) | 0.15 (0.15) | 0.18 (0.16) | 0.20 (0.20) | 0.18 (0.17) | 0.03 (0.01 to 0.05) | .003 |
| ASCs | 0.02 (0.02) | 0.02 (0.01) | 0.02 (0.02) | 0.02 (0.02) | 0.02 (0.02) | 0.02 (0.01) | −0.001 (−0.003 to 0.000) | .06 |
| Social determinants of health | ||||||||
| Socioeconomic position | ||||||||
| Median household income, $ | 60 357 (16 255) | 66 384 (19 451) | 62 419 (18 400) | 61 482 (15 159) | 60 716 (15 529) | 55 548 (13 387) | −10 835 (−12 721 to −8949) | <.001 |
| Uninsured rate, % | 10.0 (4.6) | 7.8 (3.1) | 8.0 (3.3) | 8.9 (3.7) | 9.4 (4.0) | 13.2 (5.0) | 5.42 (4.88 to 5.97) | <.001 |
| Unemployment rate, % | 4.4 (1.3) | 4.1 (1.4) | 4.3 (1.7) | 4.2 (1.0) | 4.5 (1.3) | 4.7 (0.9) | 0.62 (0.49 to 0.75) | <.001 |
| Without high school degree, % | 12.8 (5.5) | 10.1 (4.5) | 11.1 (5.7) | 11.3 (4.3) | 12.6 (4.8) | 15.9 (5.7) | 5.82 (5.18 to 6.47) | <.001 |
| Food environment index | 7.84 (0.87) | 8.06 (0.73) | 8.13 (0.78) | 7.94 (0.81) | 7.79 (0.86) | 7.57 (0.92) | −0.49 (−0.60 to −0.39) | <.001 |
| Race/ethnicity, % | ||||||||
| Hispanic | 17.7 (17) | 15.1 (13.4) | 11.8 (13.3) | 13.4 (11.9) | 16.3 (17.5) | 25.8 (19.5) | 10.71 (8.55 to 12.88) | <.001 |
| Non-Hispanic Black | 12.3 (12.6) | 3.2 (3.3) | 6.4 (7.2) | 10.2 (10.8) | 14.7 (14.0) | 18.6 (13.1) | 15.48 (14.14 to 16.81) | <.001 |
| Non-Hispanic other race | 0.2 (0.3) | 0.2 (0.2) | 0.2 (0.2) | 0.2 (0.2) | 0.2 (0.3) | 0.3 (0.3) | 0.13 (0.09 to 0.16) | <.001 |
| Noncitizens, % | 7.0 (5.5) | 6.7 (5.1) | 4.8 (4.5) | 5.5 (3.8) | 6.2 (4.6) | 9.9 (6.4) | 3.18 (2.45 to 3.92) | <.001 |
| Social relationships | ||||||||
| Social associations per 1000 population | 9.27 (3.89) | 9.63 (3.69) | 10.61 (4.17) | 9.83 (3.84) | 9.78 (3.92) | 7.66 (3.30) | −1.98 (−2.39 to −1.56) | <.001 |
| Residential and community context, % | ||||||||
| Households with severe housing problems | 18.6 (6.0) | 18.6 (4.8) | 15.5 (4.4) | 16.3 (3.9) | 18.1 (5.0) | 22.2 (7.1) | 3.53 (2.74 to 4.32) | <.001 |
| Access to exercise opportunities | 84.2 (16.0) | 85.3 (14.0) | 80.9 (16.0) | 82.5 (15.6) | 84.3 (15.9) | 86.4 (16.9) | 1.06 (−0.89 to 3.00) | .29 |
| Housing units in rural areas | 18.8 (24.4) | 25.8 (27.2) | 29.6 (27.1) | 21.1 (23.2) | 16.2 (22.4) | 11.2 (20.8) | −14.62 (−17.41 to −11.83) | <.001 |
Abbreviations: ASC, ambulatory surgery center; CMS-HCC, Centers for Medicare & Medicaid Services hierarchical condition category; HHA, home health agency; PCP, primary care physicians; NA, not applicable; RN, registered nurses; SNF, skilled nursing facility.
a
For Medicare cost and demographics, analyses were weighted by the number of fee-for-service beneficiaries in each county; for supply and social determinants, analyses were weighted by the population size in each county.