Socioeconomic Disparities for Healthcare Utilization of Senior Adult Falls in Southeast Wisconsin, 2020-2022

Background: To examine the social determinant factors of the healthcare utilizations for senior patients with history of falls. Methods: We analyzed effects of socioeconomic factors on the utilization rate of healthcare in a tertiary care center including 495,041 senior adults. We included Zip Code Tabulation Areas to measure socioeconomic factors on a community level. Cohort group comparison and multiple linear regression models evaluated the association between healthcare services utilization and age, sex, education, race, insurance type, distance, and income levels. Results: Patients with a history of falls were older than those without a history of falls (79.4, standard error = 12.1 vs. 75.4, standard error = 11.6 years old), predominantly female (odds ratio [OR]: 1.26, 95% confidence interval [95% CI]: 1.24-1.28), white (OR: 1.35, 95% CI: 1.32-1.38). Patients with a fall history were predominantly retired (OR: 2.53, 95% CI: 2.49-2.58), publicly insured (OR: 2.88, 95% CI: 2.82-2.93), and more likely to require an interpreter during a hospital visit (OR: 2.40, 95% CI: 2.35-2.44). Using a geospatial analysis, healthcare utilization was higher in areas close to the care center. A regression model showed that a community median income, private insurance rate, and college education rate were positively associated with healthcare utilization. Conclusions: Lower utilization of healthcare is associated with disadvantaged neighborhood social conditions, including under-insured status, residing far from a hospital, lower education, and lower income. We revealed the current inequities and disparities in the healthcare of senior adult fall patients in Southeast Wisconsin. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1TR001436. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH. This project is also funded by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical College of Wisconsin and Froedtert Hospital Institutional Review Board (PRO00036649) approved the OTO Clinomics platform, the interrogation of the electronic medical record, and the retrospective chart review involved in this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors, and subject to the approval of Clinical Translational Science Institute in Medical College of Wisconsin.