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theses

For several decades, social disparities in access to health care remain a major debate in the U.S. health care system. Despite growing attention to health inequalities, different social classes, especially, minority or ethnic groups, and those without health insurance coverage continue to face challenges to health care. To date, due to the complexities of Socioeconomic Status (SES), it is unclear how SES impacts health and income inequality. The purpose of this dissertation was to examine the association of SES and median household income groups with hospitalization outcomes in the United States from 2008 to 2010. To examine the generalizability of this phenomenon, a retrospective study was used to analyze the pattern of care for hospitalized patients between the ages of 18 and 89, using the National Inpatient Sample (NIS) data of the Healthcare Cost and Utilization Project (HCUP). The study sample consisted of 500,000 admission records and stratified and regression analysis were computed to determine the differences by age, sex, race or ethnicity, income, location, diagnoses, procedures, length of stay, payer, and costs affecting each of the defined income categories. Total hospital costs were examined within the categorical income groups by residential zip code and top 10 diagnoses and procedures showed that high medical costs is an issue across SES groups. Descriptive and inferential statistical analyses were performed. Mean, median, standard deviation, and range were used to calculate continuous variables while frequency counts and chi-square tests of association were conducted to evaluate differences in proportion for categorical variables. Linear regression modeling and multivariable modeling techniques were undertaken to test the hypotheses. Measurement and structural models were tested through structural equation modeling statistical techniques using SPSS version 22.0. When compared the SES differences among the four categorical income groups, the results show that people at the lower quintile were more likely to face higher hospitalization due to their income. Each year, many programs are designed to reduce hospital admissions, but regardless of these efforts the rates of hospitalization continue to increase in U.S population. This study recommended scientific approach in understanding of the role SES and income as they impact health disparities, which will potentially help health providers, researchers, policy makers, and public health planners to design individualized and community-wide programs and policies related to income inequality and hospitalization for high risk populations.

ETD_6867

doi:10.7282/T3RR219Q

Ph.D.

Includes bibliographical references

by Adiebonye E. Jumbo

ETD doctoral

The author owns the copyright to this work.