IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v56y2003i12p2541-2553.html
   My bibliography  Save this article

A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina

Author

Listed:
  • Joines, Jerry D.
  • Hertz-Picciotto, Irva
  • Carey, Timothy S.
  • Gesler, Wilbert
  • Suchindran, Chirayath

Abstract

Hospitalization rates for low back problems vary widely. In previous non-spatial analyses, population-level socioeconomic and health resource characteristics have explained little of the variation in rates. This study examines geographic variation in hospitalization rates for low back problems while controlling for spatial dependence in the data. County-level surgical and medical hospitalization rates were calculated using North Carolina hospital (USA) discharge data from 1990-92. Non-spatial and spatial regression models were estimated using socioeconomic and health resource predictors. Both surgical and medical rates varied significantly among the 100 counties. Non-spatial models explained 62% of variation in log-transformed surgical rates and 66% of variation in log-transformed medical rates; however, residuals showed significant spatial dependence. Spatial lag models were therefore applied. Using simple contiguity spatial weights, surgery rates increased with higher percent urban population, primary care physician density, and discharge rate for other causes, and decreased with higher percent college graduates, percent disabled, occupied hospital bed density, and unoccupied hospital bed density. There was a nonlinear relationship between surgery rates and percent employed in heavy lifting/transportation industries. Medical rates increased with higher other-cause discharge rate and with MRI/CT scanner availability, and decreased with higher percent urban population, percent nonwhite population, percent in heavy lifting/transportation industries, and unoccupied hospital bed density. The results show that population-level socioeconomic and health resource characteristics are important determinants of variation in low back hospitalization rates. Independent of these variables, a separate spatial process produces geographic clustering of high-rate counties. Spatial effects are important and should be considered in small area analyses.

Suggested Citation

  • Joines, Jerry D. & Hertz-Picciotto, Irva & Carey, Timothy S. & Gesler, Wilbert & Suchindran, Chirayath, 2003. "A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina," Social Science & Medicine, Elsevier, vol. 56(12), pages 2541-2553, June.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:12:p:2541-2553
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(02)00295-2
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lauridsen, Jorgen & Bech, Mickael & Lopez, Fernando & Mate Sanchez, Mariluz, 2008. "Geographic and Temporal Heterogeneity in Public Prescription Pharmaceutical Expenditures in Spain," The Review of Regional Studies, Southern Regional Science Association, vol. 38(1), pages 89-103.
    2. Massimo Filippini & Giuliano Masiero & Karine Moschetti, 2006. "Small area variations and welfare loss in the use of antibiotics in the community," Working Papers 0609, Department of Economics and Technology Management, University of Bergamo.
    3. Bech, Mickael & Lauridsen, Jørgen, 2008. "Exploring the spatial pattern in hospital admissions," Health Policy, Elsevier, vol. 87(1), pages 50-62, July.
    4. Crighton, Eric J. & Elliott, Susan J. & Moineddin, Rahim & Kanaroglou, Pavlos & Upshur, Ross, 2007. "A spatial analysis of the determinants of pneumonia and influenza hospitalizations in Ontario (1992-2001)," Social Science & Medicine, Elsevier, vol. 64(8), pages 1636-1650, April.
    5. Mickael Bech & Jørgen Lauridsen, 2009. "Exploring spatial patterns in general practice expenditure," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 243-254, July.
    6. Jorgen Lauridsen & Mariluz Sánchez & Mickael Bech, 2010. "Public pharmaceutical expenditure: identification of spatial effects," Journal of Geographical Systems, Springer, vol. 12(2), pages 175-188, June.
    7. Jorgen Lauridsen & Mickael Bech & Fernando López & Mariluz Sánchez, 2010. "A spatiotemporal analysis of public pharmaceutical expenditure," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 44(2), pages 299-314, April.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:56:y:2003:i:12:p:2541-2553. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.