Neighborhood Deprivation and Days Spent at Home After Fall-Related Hip Fracture.

Abstract

Hip fracture is a highly disabling event for older adults and increases the risk of needing prolonged care in health care facilities. Older adults in economically deprived neighborhoods may have fewer resources to support aging in place vs in a facility, but how neighborhood deprivation is associated with home time after hip fracture is unknown. To evaluate the association between neighborhood deprivation and days spent at home after hip fracture. This cohort study analyzed a random sample of Medicare claims and assessment data for beneficiaries who experienced a fall-related hip fracture from July 1, 2010, to December 31, 2019; underwent surgery (arthroplasty or internal fixation); and were discharged alive to a nonhospice home or postacute care setting. Neighborhood deprivation was assessed using the Area Deprivation Index. Data were analyzed from January 2023 to September 2025. Area Deprivation Index (ADI; range, 1-100), where the 10th percentile or lower was categorized as the least deprived, the 11th to 89th percentile as moderately deprived, and the 90th to 100th percentile as the most deprived. Days at home in the 12 months after hip fracture. The final analytical sample consisted of 52 012 older adults (mean [SD] age, 82.2 [8.1] years; 38 360 women [73.8%]) with a fall-related hip fracture. Those living in more deprived neighborhoods were more likely than those in the least deprived neighborhoods to identify as a member of a racial or ethnic minority group (Black or Hispanic, 477 of 4306 [11.1%] vs 120 of 5112 [2.3%]) and to be dually eligible for Medicaid (113 of 4306 [26.3%] vs 590 of 5112 [11.5%]). Relative to adults living in the least deprived areas, those in the most deprived areas spent 8.5% fewer days at home (incidence rate ratio [IRR], 0.92; 95% CI, 0.89-0.94), and those in the middle ADI group spent 5% fewer days at home (IRR, 0.95; 95% CI, 0.94-0.97). For patients in the most deprived neighborhoods, this resulted in an absolute difference of 22.8 days at home over the following year. In this cohort study of older adults with a fall-related hip fracture, residence in an economically deprived area was associated with fewer days at home in the 12 months after the fracture. These findings suggest neighborhood context is an important determinant of postfracture recovery and could guide development of more community-tailored interventions.