| There is well-documented variation in health outcomes and health care utilization & costs by geographic variation in the U.S., down to the level of Hospital Referral Regions (defined as a regional health care market, which may cross state boundaries, of which there are 306 in the U.S.).[9][10] There is ongoing debate as to the relative contributions of race, gender, poverty, education level and place to these variations. The Office of Epidemiology of the Maternal and Child Health Bureau recommends using an analytic approach (Fixed Effects or hybrid Fixed Effects) to research on health disparities to reduce the confounding effects of neighborhood (geographic) variables on the outcomes.[11] |
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