Exploration of Neighborhood Deprivation and Patient -level Demographics of Young Adults Receiving Care for Psychosis: Implications for Health Equity

Brittany Gouse MD MPH, (1,2) Tithi Baul MPH, (1,3) Elijah Boliver MPH, (1) Luisa Camacho MPH, (1) Jennifer Lancet MBA, MS, CPS, (1) Nandini Agarwal MPH, (1,3) Toshiaki Komura BS, (1) Hannah Brown MD (1,2)

1: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA
2: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
3: Evaluation Research Center, Department of Psychiatry, Boston Medical Center, Boston, MA

Abstract

Background: Structural inequities at the neighborhood level negatively impact access to care and targeted interventions are necessary to reduce these barriers. In the metro-Boston area, systemic factors such as housing discrimination perpetuate racial segregation. Here, we explored individual sociodemographic characteristics across area-level socioeconomic (SES) strata among young adults with psychosis receiving care at an urban, safety-net hospital.
Methods: We used an electronic-medical record derived repository (ACCESS) of all visits with a schizophrenia spectrum disorder (SSD) billing code. The analytic sample included patients ≤ to 30-years old with at least one SSD-related visit between 2015-2022. Neighborhood socioeconomic deprivation was defined by connecting individual-level EMR demographics to U.S. Census data and American Community Survey Data. Sociodemographic differences were compared across SES Social Vulnerability Index (SVI) quartiles using chi-squared tests.
Results: Among 1,197 patients, 67.2% were male, 56.5% were non-Hispanic Black, and 87.7% were English speaking. The median SVI for the cohort was 0.76 (IQR: 0). A higher proportion of non-Hispanic Black and Hispanic patients resided in census tracts that were more socioeconomically vulnerable than 75% of census tracts across Massachusetts than non-Hispanic white patients (62.5% non-Hispanic Black vs. 55.6% Hispanic vs. 24.1% non-Hispanic white, p<.001).
Conclusions: The majority of young adults with psychosis served at BMC reside in highly socioeconomically disadvantaged neighborhoods. Further, a significantly higher proportion of non-Hispanic Black and Hispanic patients resided in the census tracts in the lowest SES strata in the state compared to their non-Hispanic white counterparts. Additional resources are critically needed to mitigate structural inequities at the neighborhood level in pursuit of health equity in Massachusetts.