Type of Document	Dissertation
Author	Lemus, Frank Christopher
Author's Email Address	fclemus@utmb.edu
URN	etd-08072007-111537
Title	Community Correlates of Pneumonia Hospitalization and Mortality Among Persons 65 Years and Older in Texas Counties
Degree	PhD
Department	Preventative Medicine and Community Health
Advisory Committee	Advisor Name Title Jean L. Freeman, PhD Committee Chair C. Glen Mayhall, MD Committee Member Daniel H. Freeman, Jr., PhD Committee Member Elizabeth T. Anderson, DrPH, RN Committee Member James S. Goodwin, MD Committee Member Karl Eschbach, PhD Committee Member Michael A. Stoto Committee Member
Keywords	Residence Characteristics Health Services Research Quality Indicators Health Care Aged Pneumonia Bacterial Texas
Date of Defense	2007-07-13
Availability	unrestricted
Abstract This study contributes knowledge to the overarching goals of Healthy People 2010, as it examined an objective aimed at improving population health of a priority population in the United States. The study aims examined the effect of health care quality on pneumonia among persons 65+ in Texas counties, and considered how community (county) characteristics such as prosperity and racial/ethnic homogeneity impact population health and well-being. The project applied Evans and Stoddart determinants of health model to examine the effect and relationship of contextual factors on two AHRQ quality of health care indicators, and their influence on population health. The project utilized 1999-2001 Texas hospital discharge data to estimate county bacterial pneumonia hospitalization rates and pneumonia inpatient mortality rates. Population counts and contextual factors were derived from Census 2000 Summary Files. Population mortality rates were estimated from 1999-2001 Texas vital statistics files. Study results showed an association between increasing percent Latinos in a county and lower bacterial pneumonia hospitalization rates, not just for Latinos, but also for non-Hispanic Blacks and non-Hispanic Whites. Results indicate bacterial pneumonia hospitalization rates increase significantly with age, especially in persons 75+, with males experiencing higher rates than females. Persons with high risk of mortality scores experienced significantly higher mortality rates in the hospital setting. Community pneumonia mortality rates were similar to those for bacterial pneumonia hospitalizations, and bacterial pneumonia hospitalizations were associated with community pneumonia mortality. In summary, this research provides baseline pneumonia morbidity and mortality data for Texas counties by which to evaluate future health studies among the elderly. The methodology demonstrates the application of hospital discharge data in community based health services research and contributes to understanding neighborhood influences on population health. It may contribute to policy considerations for Texas counties by allowing stakeholders to assess population health status for funding and treatment priorities. Finally, this research represents a stepping stone to research that can guide future community-based interventions to improve care, and provides a model for other states to evaluate community correlates of mortality and morbidity. The model could potentially be applied to many different conditions affecting community health, such as immunizations.
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