Figure 4. Ambulatory Care Sensitive Admissions per 1,000 Population by ZIP Code Area Income, Baltimore, Ages 40-64, 1999

Key: Each square represents a ZIP code area.

[D] Scatter diagram of ZIP codes areas, with Percent of Households with Incomes Less Than $15,000 on one axis and Admissions per 1,000 Population on the other axis.

Figures 3 and 4 display ACS rates for the Baltimore MSA at the ZIP code level. For children, a strong association with area income exists (R2 = .595), and low-income areas of Baltimore have ACS rates 2.2 times higher than those in high-income ZIP codes. For adults age 40-64, the mean rate is substantially higher than that for children (26.7/1,000 versus 9.5/1,000), and an extraordinarily strong association exists between ACS rates and area income (R2 = .893). But of significant importance is the much larger difference between low- and high-income areas, with rates in low-income ZIP codes for adults more than 4 times higher than those in more affluent areas.

These data may suggest two important conclusions about access and performance of the safety net in Baltimore that are likely to be of interest to policymakers:

• Things are a lot worse for adults.
• The substantial investment in efforts to improve access for children has helped reduce the level of disparity (although additional progress is necessary).

This latter point is likely to be of significant importance as Federal, State, and local budget constraints force hard looks at existing programs; the ability to show that investment of resources actually seems to matter can help reinforce support for these programs.

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