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# Neighbourhood deprivation and excess mortality after clinical risk adjustment in Medicare
- URL: https://www.coios.me/neighbourhood-deprivation-and-excess-mortality-after/
- Published: 2026-10-26T23:22:40.000Z
- Updated: 2026-10-27T07:06:25.000Z
- Description: Among 4,477,014 Medicare beneficiaries, excess mortality was 0.5 percentage points higher in the most deprived decile than the middle.
- Author: Daniel Ryan
- Tags: Data, models and systems, Health systems and access, United States, #peer-reviewed, #confirms, #item, #source-2026-10, #score-62

The study asked whether neighbourhood socioeconomic disadvantage predicts mortality beyond clinical risk adjustment. It used a 20% sample of 2018 to 2019 Medicare claims covering 4,477,014 beneficiaries. Exposures were beneficiary-level Hierarchical Condition Category (HCC) score components and Area Deprivation Index (ADI) decile. Excess mortality was 0.5 percentage points higher in the most deprived ADI decile than the middle decile. The 95% CI was 0.4 to 0.6 percentage points. The design was cross-sectional and retrospective, and deprivation was measured at area level rather than for each person.

*Why it is interesting: Medicare payment models already adjust benchmarks using area deprivation indices. This study tests whether that adjustment captures mortality risk that clinical HCC scores miss.*

Source

[Medical Care Research and Review, 25 October 2026](https://doi.org/10.1177/10775587261495395?ref=coios.me)

Paper

Association of Neighborhood Socioeconomic Disadvantage With Excess Mortality Among Medicare Beneficiaries: Examining an Empirical Basis for Social Risk Adjustment

Authors

Kilaru AS, Amagai K, Crowley AP, Browne DS, Shirk T, Cousins DS et al.

DOI

10.1177/10775587261495395

Type

Peer-reviewed article

Design

Retrospective cross-sectional study of a 20% sample of 2018-2019 US Medicare claims, 4,477,014 beneficiaries, ADI decile vs HCC-adjusted mortality

Verdict

Confirms prior evidence

Driver

[Health systems and access](https://www.coios.me/d-health-systems/)

Free full text

[Free to read at the publisher](https://doi.org/10.1177/10775587261495395?ref=coios.me)