Importance The Neighborhood Atlas Area Deprivation Index (NA-ADI) has been widely used in health policy research and incorporated into Medicare payment models such as the Accountable Care Organization Realizing Equity, Access, and Community Health model. However, calculation errors have been independently identified by multiple groups, showing that the NA-ADI contains distorted deprivation estimates that pose risks to equitable funding allocation and outcome adjustment. Objective To develop the Reproducible ADI (ReADI) as a corrected, transparent replacement aligned with the original ADI methodology and to compare its agreement with established deprivation indices, including the Social Vulnerability Index (SVI), Social Deprivation Index, French Deprivation Index, and Neighborhood Stress Score, and its performance for estimating mortality. Design, Setting, and Participants This cross-sectional study used 2011-2015 and 2018-2022 data from the American Community Survey (ACS), a population-based US sample across census block groups, tracts, and counties. US geographic levels with sufficient data included 235 952 block groups, 83 722 census tracts, and 3214 counties. Census tract–level 2011-2015 mortality data were obtained from the US Small-Area Life Expectancy Estimates Project. Data from the 2015 NA-ADI were accessed March 7, 2024, and data from the 2022 NA-ADI, December 1, 2024. Exposures The ReADI was constructed using corrected methods described in the original work developing the ADI. The NA-ADI was downloaded and aggregated to tract and county levels. The SVI was from the Centers for Disease Control and Prevention. Other indices were independently constructed from the ACS. Main Outcomes and Measures The primary outcomes were ReADI and NA-ADI comparisons against each other, other deprivation indices, and mortality. Results The ReADI more closely aligned with other deprivation indices ( R 2 range, 0.609 95% CI, 0.586-0.630 to 0.932 95% CI, 0.931-0.933) compared with the NA-ADI ( R 2 range, 0.331 95% CI, 0.300-0.362 to 0.710 95% CI, 0.692-0.727). ReADI scores also better reflected component weights ( R 2 ≥ 0.999 95% CI, 0.996-1.000; RMSE ≤ 0.042 95% CI, 0.029-0.053) compared with the NA-ADI ( R 2 range, 0.832 95% CI, 0.574-0.932 to 0.844 95% CI, 0.601-0.937; RMSE range, 0.346 95% CI, 0.279-0.414 to 0.405 95% CI, 0.334-0.470), consistent with correct computation. In 3332 high-discrepancy census tracts representing approximately 13 million individuals, the ReADI explained more variance in life expectancy ( R 2 difference, 0.064; 95% CI, 0.039-0.090), particularly in underresourced urban areas. Conclusions and Relevance In this cross-sectional study, the ReADI was correctly calculated and should replace the flawed NA-ADI for future health policy applications. Its open-source methods support transparency, adaptability, and further development.
Gladish et al. (Mon,) studied this question.