25 Cities Where You Don’t Want to Get Sick

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25. Sierra Vista-Douglas, AZ
> 30 day readmission rate: 16.4% (highest 10%)
> 30 day mortality rate: 13.3%
> Preventable hospitalizations: 48.6 per 1,000 patients
> No. of physicians: 46.7 per 100,000 (lowest 10%)
> Median household income: $45,508 (lowest 25%)

The Sierra Vista-Douglas metro area health system reports poor quality hospital care. The rates of readmission and mortality after 30 days, as well as the preventable hospitalization rate, are above the average across the nation’s hospitals. The 30-day mortality rate for stroke patients is especially poor, as nearly 1 in every 5 stroke patients (18%) will die within 30 days after being admitted to an area hospital, the 11th highest rate of all metro areas and significantly higher than the national 30-day mortality rate of 1 in every 7 stroke patients (14.6%). There are only 47 primary care physicians working in the Sierra Vista area per 100,000 residents, one of the lowest such proportions. Nationwide, there are 76 primary care physicians per 100,000 people.

Like nearly every city on this list, Sierra Vista-Douglas metro area hospitals serve a relatively disadvantaged population, at least in terms of income. The typical household earns $45,508 annually, well below the national median of $57,617.

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24. Florence-Muscle Shoals, AL
> 30 day readmission rate: 15.7% (highest 25%)
> 30 day mortality rate: 13.6%
> Preventable hospitalizations: 67.1 per 1,000 patients (highest 10%)
> No. of physicians: 56.5 per 100,000 (lowest 25%)
> Median household income: $45,287 (lowest 25%)

Avoidable hospitalizations are costly, disruptive, and can be disorienting for some, if not most, patients. More time spent at the hospital also means a higher likelihood of hospital-acquired infections. These unnecessary inpatient admissions tend to reflect inefficiencies in a health system, from issues of poor communication to low-quality or lack of outpatient services to staff failing to observe best practices. Across Florence-Muscle Shoals hospitals, there are approximately 67 preventable hospitalizations for every 1,000 patients, compared to the average preventable hospitalization rate nationwide of 50 per 1,000 patients.

Readmission within 30 days for most area patients were in line with the national average rates, except for pneumonia patients. Nearly 18% of pneumonia patients return to the hospital within 30 days of admission, one of the higher percentages of all metro areas.

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23. Visalia-Porterville, CA
> 30 day readmission rate: 15.5%
> 30 day mortality rate: 14.5% (highest 10%)
> Preventable hospitalizations: 50.3 per 1,000 patients
> No. of physicians: 44.1 per 100,000 (lowest 10%)
> Median household income: $45,881 (lowest 25%)

Unlike other metro areas with relatively low-rated hospitals, mortality rates among Visalia-Porterville patients admitted for heart attacks and coronary artery bypass surgery are better than nationwide average rates — at 13.3% and 2.1%, respectively. For stroke and pneumonia patients, on the other hand, the likelihood of dying after hospitalization is considerably greater than it is in most metro areas.

Socioeconomic conditions likely contribute to the area’s poor hospital ratings. At 25.2%, the Visalia area’s poverty rate is sixth highest of all U.S. metro areas. Individuals living in poverty are at greater risk of certain health conditions. The number of doctors serving the metro area is also well below the national average. For every 100,000 residents, there are only 44 primary care physicians, versus 76 doctors per 100,000 people nationwide.

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22. Altoona, PA
> 30 day readmission rate: 15.2%
> 30 day mortality rate: 14.9% (highest 10%)
> Preventable hospitalizations: 53.8 per 1,000 patients
> No. of physicians: 82.8 per 100,000
> Median household income: $43,443 (lowest 25%)

Altoona is the only metro area in Pennsylvania on this list, which makes the area’s hospitals the worst in the state and among the worst in the country. Of those admitted to area hospitals, approximately 15% die within 30 days, the 10th highest 30-day mortality rate of all U.S. metros. The area’s high mortality rate is largely driven by an especially high pneumonia mortality rate. Nearly 1 in 5 patients (19.3%) admitted for pneumonia in Altoona die within 30 days, the 13th highest rate of all U.S. metro areas. By contrast, fewer than 1 in 6 pneumonia patients (15.9%) die within 30 days of hospital admission nationwide.

Most metro areas on this list are home to relatively under-staffed hospitals serving relatively low-income communities. Altoona is one of the few with a lower poverty rate than the national rate, at 12.9%, and an above average ratio of primary care physicians per capita, at 83 for every 100,000 residents.

21. Merced, CA
> 30 day readmission rate: 16.4% (highest 10%)
> 30 day mortality rate: 13.6%
> Preventable hospitalizations: 45.0 per 1,000 patients
> No. of physicians: 46.6 per 100,000 (lowest 10%)
> Median household income: $47,739

Recent research by the Association of American Medical Colleges and other organizations has revealed a growing doctor shortage in the United States. The ratio of primary care physicians per population is in some regions considerably lower than 76 per 100,000 people nationwide, particularly in metro areas with low-rated hospitals. Merced is one such case, with fewer than 50 doctors per 100,000 area residents. The area also reports above average readmission and mortality rates, although unlike the vast majority of metros with low-rated hospitals, Merced’s preventable hospitalization rate of 45 per 1,000 patients is lower than the national rate of 50 avoidable hospitalizations per 1,000 patients.

Approximately 20% of Merced residents live in poverty, one of the highest rates in the nation, but not unusually high for metro areas on this list. Individuals with low incomes are seemingly more likely to live in areas with relatively low-rated hospitals. Financial hardship of any kind also tends to increase the risk of certain health conditions.