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Objective: To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital valuebased purchasing (HVBP) scores. Data Sources and Study Setting: This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015-2019. Study Design: This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables. Data Collection/Extraction Methods: We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file. Principal Findings: Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19-64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS ([beta] = -12.79, p < 0.0001), followed by the percent of the population coded to 'non-Hispanic, some other race' ([beta] = -2.59, p < 0.0023), and the percent of families in poverty ([beta] = -0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native ([beta] = 0.35, p < 0.0001) and percent non-Hispanic Asian ([beta] = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores. Conclusions: The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent-that is, structural-association between market sociodemographics and HVBP scores. KEYWORDS hospitals, patient satisfaction, pay for performance, quality of healthcare, spatial analysis, systemic racism What is known on this topic * Medicare's hospital value-based purchasing program scores have been shown to be lower for safety-net hospitals, resulting in reduced Medicare reimbursement. * There has been a call to adjust the scores for the socioeconomic status of patients seen by each hospital, but regulators have resisted holding these hospitals to a lower standard. * The local and regional geographic impact of these policies across the United States has not been explored. What this study adds * We created maps showing how the hospital scores were potentially affected by the sociodemographic characteristics of their market areas. * Hospitals in the Southeastern states and larger cities with racial and ethnic diversity had lower predicted scores, potentially representing an increased risk of lower hospital valuebased purchasing program scores. * Patient experience, patient safety, and hospitalization related costs contributed to the lower predicted scores. There was less evidence of regional geographic patterns in clinical quality., 1 | INTRODUCTION The Centers for Medicare and Medicaid Services (CMS) implemented hospital value-based purchasing (HVBP) for acute care hospitals starting with 2012 discharges as part of the Affordable Care [...]

Syphilis patients may have a higher risk of death from other types of high-risk behavior than other individuals. Among 16,257 individuals diagnosed with syphilis between Jan 1972 and Dec 1987, 928 died between 1973 and 1987. The number of deaths was equivalent to the expected number for both men and women. The number of deaths among men between 25 and 54 years old was higher than expected, and the largest number of deaths occurred among men between 25 and 34 years old. AIDS was the main cause of the increased number of deaths among younger men. The second most important cause was different types of alcohol-associated deaths. These included cirrhosis, alcoholism, oral cancer and homicide. Alcohol-associated deaths also increased the death rate among female patients with syphilis.