Thanks everyone for your comprehensive dialogue so far—it is rare to have all experts and authors commenting in the first two days! We are grateful for the time you put in to sharing your knowledge with us.
My next question pertains to patient characteristics in the study and the interesting trend that developed from the hospital case-mix strata (Table 1). In Table 1, in the row that details median household income percentile, it seems that the stratum of hospitals that admitted the healthiest patients (Stratum 1) also had the lowest median household income level percentile (44.7), while the stratum with the sickest patients (Stratum 5), had the highest median household income level percentile (54.6). Granted, the standard deviations are quite large (28.6 and 29.1); however, the trend of increasing median household income percentile with decreasing patient health is intriguing. Could the authors and experts comment on this trend and offer potential explanations for this finding? Why are wealthier patients the ones who are seemingly sicker? Although all patients were Medicare beneficiaries, perhaps this speaks to a broader point of an unequal access to care for poorer patients?
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