Paper Information

Associations between higher SDI and outcomes were statistically detectable but small in absolute magnitude. Guideline-concordant management was associated with shorter LOS, better DOOR, and lower revisit, mortality, and CDI risks; overuse was consistently associated with worse outcomes, whereas underuse showed mixed associations. Concordance mediated only a small share of SDI-associated outcome differences. Sensitivity analyses using a 4-level DOOR outcome, modified Poisson relative risks, and study-period stratification supported the principal interpretation.

Older adults evaluated in emergency departments (EDs) frequently receive antibiotics, but the relationships among neighborhood deprivation, antibiotic decision concordance, and downstream outcomes remain incompletely defined.

We conducted a retrospective cohort study of 1 365 957 ED encounters among adults aged ≥65 years at 119 CommonSpirit Health facilities across 15 US states (2015-2024). Census-tract Social Deprivation Index (SDI) was standardized for modeling. Indication-level concordance, overuse, and underuse were based on antibiotics administered during the index ED encounter and an encounter-level diagnosis-tier framework. Outcomes were length of stay (LOS), 30-day ED revisit, mortality, Clostridioides difficile infection (CDI), and desirability of outcome ranking (DOOR).

Neighborhood deprivation had small absolute associations with short-term outcomes. Indication-level concordance and avoidance of overuse were associated with more substantial outcome differences but explained little of the deprivation-associated variation.