25 Cities Where You Don’t Want to Get Sick

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25. Mobile, AL
> 30-day hospital readmission rate: 15.6%
> Mortality within 30 days of hospitalization: 13.2%
> Preventable hospitalizations: 60.7 per 1,000 Medicare enrollees
> No. of physicians: 65.6 per 100,000
> Median household income: $43,061

There are only about 66 primary care physicians for every 100,000 people in Mobile, Alabama, lower than the national concentration of 75 per 100,000. An inadequate number of doctors in a city can make it more difficult to seek necessary preventive and primary care, which can lead to an overreliance on hospitals. And in Mobile, a larger than typical share of residents are hospitalized for conditions that could or should have been treated in an outpatient setting. There are about 61 preventable hospitalizations for every 1,000 Medicare enrollees in the metro area, compared to 45 per 1,000 nationwide.

As is the case in most metro areas on this list, Mobile residents are more likely to be disadvantaged economically than the typical American. The median annual household income in Mobile is $43,061, well below the national median of $61,937.

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24. Beckley, WV
> 30-day hospital readmission rate: 15.7%
> Mortality within 30 days of hospitalization: 12.5%
> Preventable hospitalizations: 69.6 per 1,000 Medicare enrollees
> No. of physicians: 74.4 per 100,000
> Median household income: $38,917

One of the main indicators of hospital quality is the share of patients being readmitted after discharge. Readmissions can occur due to poor post-acute care, medical complications during initial hospital stays, poor patient discharge instructions, or for other, non-preventable medical reasons. In Beckley, 17.0% of all heart attack patients are readmitted to the hospital after 30 days, the 12th largest share of any U.S. metro area. Additionally, 24.3% of patients with heart failure return to the hospital within 30 days of discharge, the eighth largest share.

Another measure of health care quality is the number of patients hospitalized for conditions that are treatable in an outpatient setting — often an indication of poor outpatient treatment. In Beckley, there are 70 preventable hospitalizations per 1,000 Medicare enrollees, the ninth highest ratio in the country.

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23. Goldsboro, NC
> 30-day hospital readmission rate: 15.7%
> Mortality within 30 days of hospitalization: 14.3%
> Preventable hospitalizations: 47.6 per 1,000 Medicare enrollees
> No. of physicians: 51.6 per 100,000
> Median household income: $40,791

Along with Burlington and Rocky Mount, Goldsboro is one of three North Carolina metro areas to rank on this list. In Goldsboro, some 14.3% of patents die within 30 days of being admitted to a hospital’s care, one of the highest rates of any metro area and well above the corresponding 12.4% national rate.

Wealthier Americans are better equipped to afford regular, preventative health care and can afford a greater range of healthy options related to diet and lifestyle — and as a result, income is closely linked to health outcomes. As is the case in most metro areas on this list, Goldsboro residents are more likely to be disadvantaged economically than the typical American. The median annual household income in Goldsboro is just $40,791, over $20,000 below the national median of $61,937.

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22. Gulfport-Biloxi, MS
> 30-day hospital readmission rate: 15.9%
> Mortality within 30 days of hospitalization: 13.1%
> Preventable hospitalizations: 59.5 per 1,000 Medicare enrollees
> No. of physicians: 50.9 per 100,000
> Median household income: $47,444

There are just 51 primary care physicians per 100,000 residents in the Gulfport-Biloxi metro area, far less than the national concentration of 75 physicians per 100,000 Americans. With less access to outpatient treatment, Gulfport residents may be more likely to visit the hospital for conditions that are treatable in a primary care setting, putting themselves at unnecessary risk of infection or increased frailty from inactivity during their hospital stay. There are 60 such preventable hospitalizations in Gulfport per 1,000 Medicare enrollees, among the most of any U.S. metro area.

Poorer areas often have worse healthcare systems than wealthier areas. In Gulfport, the typical household has an income of $47,444 a year, approximately $14,500 less than the U.S. median.

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21. Burlington, NC
> 30-day hospital readmission rate: 15.0%
> Mortality within 30 days of hospitalization: 15.4%
> Preventable hospitalizations: 44.9 per 1,000 Medicare enrollees
> No. of physicians: 47.0 per 100,000
> Median household income: $49,979

Burlington, North Carolina, has the second highest post-hospitalization mortality rate of any metro area in the United States. Some 15.4% of patients die within 30 days of being admitted to the hospital, the second largest share of any U.S. metro area and well above the national rate of 12.4%.

The high post-hospitalization mortality rate may be attributable in part to the insufficient number of available doctors in Burlington. There are just 47 primary care physicians for every 100,000 metro area residents, a smaller concentration than in the vast majority of metro areas. For context, there are 75 primary care physicians per 100,000 people nationwide.