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other·public health, epidemiology, research methods, observational study·PMC10248774

Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study

Journal of Medical Internet Research · 4 authors, 1 centre

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TL;DR

The central result was an increased use of health equity-related terms across all 29 analyzed themes over the decade, though usage did not always align with public interest or indicate concrete action.

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This observational text analysis examined the free-response sections of IRS Form 990 Schedule H (F990H) submitted by US nonprofit hospitals from 2010 to 2019. Researchers developed a list of 152 key phrases across 29 health equity and disparities themes, validated with stakeholder input. Geographic variation was assessed using the Moran I statistic, revealing significant clustering for themes like homelessness, equity, and substance use. Semantic search indicated some increased mentions were to explicitly state no action was taken. The findings suggest increased hospital awareness but potential misalignment with documented community needs and public interests.

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other

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public health

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AI pipeline

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ORIGINAL PAPER

PMC10248774

Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study

Journal of Medical Internet Research

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ABSTRACT

Background Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. Objective This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. Methods We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. Results We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity , health IT , immigration , LGBTQ, oral health , rural , social determinants of health , and substance use showed statistically significant ( P <.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ , disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. Conclusions Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements.

CITATION EXPORT

Emily Hadley, Laura Haak Marcial, Wes Quattrone et al.. Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study. Journal of Medical Internet Research. (2023). https://doi.org/10.2196/44330

AUTHORS

4 · 1 CENTRES

Emily Hadley, Laura Haak Marcial, Wes Quattrone, Georgiy Bobashev

1 RTI International Durham, NC United States

EDITOR / REVIEWER

Amaryllis Mavragani, Katherine Chen, Daniela Valdes, Manabu Torii