The study, released last week by the state Office of Financial Management, examined a variety of hospital stays that generally might be avoided with proper care, including regular checkups and vaccinations.

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South Sound residents wind up hospitalized more than anyone else in Washington for ailments that could be easily prevented — such as diabetes mismanagement or dehydration — at a cost of millions of dollars, according to a state study.

The study, released last week by the state Office of Financial Management, examined a variety of hospital stays that might generally have been avoided with proper care, including regular checkups and vaccinations, from 2013 to 2015.

Of the nearly 150,000 hospitalizations studied, almost every area with more than the state average was in the southwest quarter of Washington.

The results are in line with other analyses — including a 2016 study of life-expectancy rates — that show Washington’s worst public-health situation is found in Tacoma and points directly south.

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The two areas in the state that had hospitalization rates better than the state average for all 11 conditions the study examined were in King County: the 46th Legislative District, which is mostly in Seattle, and the Eastside’s 41st District, which includes Bellevue and Mercer Island.

Underlying reasons for the South Sound region’s troubles, experts said, are a complex mix of poverty, lack of access to everyday medical care, poor public nutrition and other factors ranging from cultural to economic.

“Poor health behaviors wind up having long-term consequences,” said Joe Campo, a senior research analyst who compiled the study for the state.

The result: The region generally, and especially an area from Tacoma to Lakewood and Spanaway, is worse at keeping people out of the hospital than poor rural districts in the eastern half of the state.

The expense is huge. The official cost of all these preventable hospital stays runs to about $487 million a year, the study found. Actual bills usually run higher than estimated costs, which are used to calculate reimbursements.

Possible remedies, whether through small programs or big ones, have been delayed for want of money.

State and local health agencies got a fraction of what they wanted for community-health programs, such as preventing communicable diseases and improving maternal care.

A pitch for clinic funding in the state’s capital budget missed the cut for the spending bill, which then didn’t pass anyway.

The state evaluation broke down the situation by legislative districts.

The district that runs through South Tacoma, Lakewood and Spanaway came off so poorly that it was labeled an “extreme outlier” in some categories.

Where the statewide average was 645 preventable hospital stays per 100,000 people during 2013-15, that district had double the average, with 1,299 hospitalizations per 100,000 residents.

Second-worst was the north part of Tacoma, which had 1,041 hospitalizations per 100,000 residents.

Those preventable hospital stays cost $15 million more a year than in the average Washington district, the study found.

As bad as those numbers look, the true disparity in the South Sound could be worse — the study counted all state residents who spent time at Washington or Oregon public hospitals, but it didn’t count patients at the Madigan Army Medical Center or other federal hospitals.

The underlying reasons people don’t get proper pre-hospital care are difficult to address, said Eric Herman, MultiCare’s medical director for populations health. Transportation to recurring medical appointments is one set of issues, he said. Persuading people to see doctors regularly and get vaccinated as adults is another.

The Tacoma area has higher-than-average rates of people with diabetes and heart disease, Herman said, which has further complicated attempts to improve the overall population’s health.

A state legislator in the worst area in the study said government resources have been inadequate.

“This study is really getting at why don’t we have reasonable access to primary-care needs,” said state Rep. David Sawyer, D-Parkland, whose district ranked worst in the state. “We have a couple of clinics, but clearly the study is showing we don’t have enough.”

The Tacoma-Pierce County Health Department, in a news release, said the study “may show need for more investment in changing the underlying factors that influence health.”

In a 2015 countywide study, the Health Department found that life expectancies can vary by close to a decade between neighboring ZIP codes.

The agency Tuesday said improving awareness and access to checkups, vaccinations and the prevention of smoking and diabetes would improve the health disparities its maps identified in Lakewood and Hilltop, among other areas.

“These early interventions help people lead healthier lives,” Health Department Director Anthony L-T Chen said. “Healthier people are better employees and better learners.”