The effects of neighborhood socioeconomic characteristics and spatial access to healthcare facilities on potentially preventable conditions of emergency department visits for adults in Texas coastal bend urban areas

The objective of this thesis is to explore the associate effects of spatial access to healthcare facilities and neighborhood socioeconomic characteristics on potentially preventable conditions of emergency department visits (PPCEDs) rates for adults ages 18 to 64 years old in the Coastal Bend urban areas of Texas. The emergency department (ED) visits data were obtained from all local hospital systems in the 15 counties in the Coastal Bend Area from September 1, 2009 to August 31, 2015. The neighborhood socioeconomic characteristics data, which include Education, Employment, Hispanic, Insurance, Language and Poverty, were obtained from the U.S. Census American Community Study 2010-2014 summary data. The adult PPCEDs were estimated based on the NYU Algorithm from ED visits data. The healthcare facilities data were obtained from InfoUSA, which is a residential and business database. The spatial access to hospitals and to general facilities, respectively, at the zip code level were measured by the enhanced two-step floating catchment area (E2SFCA) method. Both driving and transit models were considered. Multivariable regression models were used to estimate associations of adult PPCEDs rates with the spatial accessibility and socioeconomic factors. The main findings of spatial access (both driving and transit) to healthcare facilities are: 1) In the urban areas, Nueces county belongs to the highest spatial accessibility group; San Patricio county belongs to the second highest spatial accessibility group; other urban areas belong to the least spatial accessibility group with different values. 2) In all the Coastal Bend area, Nueces county (urban area) belongs to the highest spatial access group to healthcare facilities; however, the central part of San Patricio (rural area) belongs to the second highest spatial access group to hospitals; meanwhile, the central part of San Patricio, the north area of Kleberg and Brooks, and the south area of Jim Wells (rural areas) belong to the second highest spatial access group to general facilities with different values. For the neighborhood socioeconomic effects on adult PPCEDs rate in the Coastal Bend urban areas, 1) The neighborhood socioeconomic factors, Education and Insurance, have significantly positive correlations with adult PPCEDs rate. A higher rate of the adult population with a lower-than-high-school education level and a higher rate of the adult population in uninsured health situations resulted in a higher rate of adult PPCEDs at the zip code level. 2) However, Employee, Hispanic (racial/ethnic) and Poverty have negative but not significant correlations with PPCEDs rate at the zip code level. The increasing rate of the adult population of unemployed status, the total adult Hispanic population, and the adult population below-poverty-level decreased the PPCEDs rate. For the spatial accessibility effects on adult PPCEDs rate in the Coastal Bend urban areas, 1) Spatial access to hospitals and spatial access to general facilities have inverse effects on adult PPCEDs rate at the zip code level. Poorer access to hospitals and easier access to general facilities in urban areas contributed to a higher adult PPCEDs rate at the zip code level. The research results provide useful information for health providers and policy makers to take actions to increase equitable spatial access to healthcare facilities and increase the number of adults with medical home care. These actions could help decrease the PPCEDs use and improve the healthcare quality for adults in the Coastal Bend urban areas.