Introduction
In an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending,
efforts to address the root causes of health are urgently needed. Research linking
medical spending to variation in neighborhood resources is critical to building the
case for increased funding for social conditions. However, few studies link neighborhood
factors to medical spending. This study assesses the relationship between neighborhood
social and environmental resources and medical spending across the spending distribution.
Methods
Individual-level health outcomes were drawn from a sample of Medicaid enrollees living
in Baltimore, Maryland during 2016. A multidimensional index of neighborhood social
and environmental resources was created and stratified by tertile (high, medium, and
low). Differences were examined in individual-level medical spending associated with
living in high-, medium-, or low-resource neighborhoods in unadjusted and adjusted
2-part models and quantile regression models. Analyses were conducted in 2019.
Results
Enrollees who live in neighborhoods with low social and environmental resources incur
significantly higher spending at the mean and across the distribution of medical spending
even after controlling for age, race, sex, and morbidity than those who live in neighborhoods
with high social and environmental resources. On average, this spending difference
between individuals in low- and those in high-resource neighborhoods is estimated
to be $523.60 per person per year.
Conclusions
Living in neighborhoods with low (versus those with high) resources is associated
with higher individual-level medical spending across the distribution of medical spending.
Findings suggest potential benefits from efforts to address the social and environmental
context of neighborhoods in addition to the traditional orientation to addressing
individual behavior and risk.
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Article Info
Publication History
Published online: May 23, 2021
Identification
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© 2021 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
