ImportanceInsurance coverage expansion has been proposed as a solution to improving health disparities, but insurance expansion alone may be insufficient to alleviate care access barriers.ObjectiveTo assess the association of Area Deprivation Index (ADI) with postsurgical textbook outcomes (TO) and presentation acuity for individuals with private insurance or Medicare.Design, Setting, and ParticipantsThis cohort study used data from the National Surgical Quality Improvement Program (2013-2019) merged with electronic health record data from 3 academic health care systems. Data were analyzed from June 2022 to August 2023.ExposureLiving in a neighborhood with an ADI greater than 85.Main Outcomes and MeasuresTO, defined as absence of unplanned reoperations, Clavien-Dindo grade 4 complications, mortality, emergency department visits/observation stays, and readmissions, and presentation acuity, defined as having preoperative acute serious conditions (PASC) and urgent or emergent cases.ResultsAmong a cohort of 29 924 patients, the mean (SD) age was 60.6 (15.6) years; 16 424 (54.9%) were female, and 13 500 (45.1) were male. A total of 14 306 patients had private insurance and 15 618 had Medicare. Patients in highly deprived neighborhoods (5536 patients [18.5%]), with an ADI greater than 85, had lower/worse odds of TO in both the private insurance group (adjusted odds ratio [aOR], 0.87; 95% CI, 0.76-0.99; P = .04) and Medicare group (aOR, 0.90; 95% CI, 0.82-1.00; P = .04) and higher odds of PASC and urgent or emergent cases. The association of ADIs greater than 85 with TO lost significance after adjusting for PASC and urgent/emergent cases. Differences in the probability of TO between the lowest-risk (ADI ≤85, no PASC, and elective surgery) and highest-risk (ADI >85, PASC, and urgent/emergent surgery) scenarios stratified by frailty were highest for very frail patients (Risk Analysis Index ≥40) with differences of 40.2% and 43.1% for those with private insurance and Medicare, respectively.Conclusions and RelevanceThis study found that patients living in highly deprived neighborhoods had lower/worse odds of TO and higher presentation acuity despite having private insurance or Medicare. These findings suggest that insurance coverage expansion alone is insufficient to overcome health care disparities, possibly due to persistent barriers to preventive care and other complex causes of health inequities.

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介绍居住在高度贫困社区的拥有健康保险的患者的视力和手术结果

重要性已提出扩大保险覆盖范围作为改善健康差距的解决方案，但仅扩大保险范围可能不足以缓解获得护理的障碍。目的评估面积剥夺指数 (ADI) 与术后教科书结果 (TO) 和个人表现敏锐度的关系设计、设置和参与者这项队列研究使用了国家手术质量改进计划（2013-2019）的数据，并合并了来自 3 个学术医疗保健系统的电子健康记录数据。数据分析时间为 2022 年 6 月至 2023 年 8 月。暴露生活在 ADI 大于 85 的社区。主要结果和措施TO，定义为没有计划外再次手术、Clavien-Dindo 4 级并发症、死亡率、急诊科就诊/观察时间以及再入院和就诊敏锐度，定义为术前患有急性严重疾病 (PASC) 和紧急或紧急病例。 结果 在 29 924 名患者的队列中，平均 (SD) 年龄为 60.6 (15.6) 岁；女性 16 424 人（54.9%），男性 13 500 人（45.1%）。共有 14 306 名患者拥有私人保险，15 618 名患者拥有医疗保险。高度贫困社区的患者（5536 名患者 [18.5%]），其 ADI 大于 85，在私人保险组中的 TO 几率较低/较差（调整后的比值比 [aOR]，0.87；95% CI，0.76- 0.99；磷= .04) 和医疗保险组 (aOR, 0.90; 95% CI, 0.82-1.00;磷= .04) 以及 PASC 和紧急或紧急病例的几率更高。在调整 PASC 和紧急/急症病例后，ADI 大于 85 与 TO 的关联失去了意义。按虚弱程度分层的最低风险（ADI ≤ 85、无 PASC 和择期手术）和最高风险（ADI > 85、PASC 和紧急/急诊手术）情景之间的 TO 概率差异最高非常虚弱的患者（风险分析指数≥40），对于拥有私人保险和医疗保险的患者，差异分别为 40.2% 和 43.1%。 结论和相关性本研究发现，生活在高度贫困社区的患者 TO 发生率较低/较差，且就诊情况较高尽管有私人保险或医疗保险，但仍具有敏锐度。这些研究结果表明，仅扩大保险覆盖范围不足以克服医疗保健差距，这可能是由于预防性护理的持续障碍和健康不平等的其他复杂原因造成的。