Limitations of the Area Deprivation Index in Assessing Neighborhood Health

Recent research presented at the ATS 2025 International Conference indicates that the widely used Area Deprivation Index (ADI) may not reliably measure the true socioeconomic conditions and health risks of neighborhoods, particularly in regions with high living costs like San Francisco. Although the ADI is a standard tool incorporated by agencies such as the Center for Medicare and Medicaid Services to allocate healthcare resources, its effectiveness in diverse contexts is being questioned.

In a study involving nearly 900 critically ill sepsis patients from San Francisco hospitals, researchers found significant discrepancies between the ADI and the Healthy Places Index (HPI). Notably, the ADI erroneously classified a struggling neighborhood in San Francisco as highly privileged, whereas the HPI provided a more accurate assessment of the neighborhood's socioeconomic challenges. Furthermore, the HPI proved a better predictor of mortality risk among hospitalized patients.

Dr. Kathryn Sullivan, the study’s lead author and a pulmonologist at UCSF, pointed out that although the ADI is validated at a national level, it exhibits limitations in specific urban settings with elevated housing costs. She emphasized that residents in high-cost neighborhoods facing poverty and resource scarcity might be misclassified as thriving communities.

The study methodology involved comparing neighborhood classifications using ADI and HPI against actual patient outcomes. Results revealed a substantial mismatch in neighborhood rankings, with the HPI more closely aligned with patients’ health outcomes. Specifically, living in a highly disadvantaged neighborhood as per the HPI correlated with increased hospital mortality risk, a relationship not evident when using the ADI.

This finding highlights the importance of refining existing measurement tools like the ADI to ensure they accurately reflect neighborhood disadvantage, especially when these metrics inform healthcare resource distribution. The research also underscores that neighborhood factors influence not only chronic diseases but can also impact the severity and outcomes of acute illnesses. The team plans further research to understand why the ADI underperforms in certain regions and intends to test these tools in more rural settings.

Overall, this study advocates for a nuanced approach to neighborhood health assessment, encouraging the development of more precise socioeconomic indices to guide equitable healthcare strategies.