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Access to Health Care in America
TABLE 3-25 Admission Rates for Selected Ambulatory-Care-Sensitive Conditions, by Zip Code/Income Groups, 1988, 11 States a
Low-Income Admissions/ 1,000 Population
High-Income Admissions/1,000 Population
Ratio, Low/High Income
Grand mal status
Chronic obstructive pulmonary disease
Congestive heart failure
a California, Florida, Illinois, Massachusetts, Nevada, New Hampshire, New Jersey, New York, Oregon, Vermont, Washington.
SOURCE: Joint data and analysis by the Codman Research Group, the Ambulatory Care Access Project (United Hospital Fund of New York), and the IOM Access Monitoring Committee.
ratio. All of the ambulatory-care-sensitive admission rates were substantially higher for low-income areas. The greatest differences—ranging in size from six– to sevenfold—were related to admissions for congestive heart failure, hypertension, and asthma. However, even angina, the diagnosis with the lowest ratio (and thus the least difference between rates), showed income differences of almost threefold. The overall average rate of difference was 4.65.
Billings and his colleagues (1991), examining New York City discharge data, looked at the effects of race, substance abuse, and prevalence of disease conditions on the differences between high– and low-income areas. They found that predominantly black middle-income zip codes resembled other middle-class areas but that poor black areas had consistently higher admission rates than comparable white low-income zip codes. By examining secondary diagnoses of alcohol and drug dependence/abuse, they noted that, although alcohol/substance abuse explains some of the differentials for the 22– to 44–year-old population with respect to bacterial pneumonia and tuberculosis, for the most part such abuse has little impact on rates for most