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Where patient resides predicted risk for rehospitalization
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Patients hospitalized for HF, MI or pneumonia were more likely to be readmitted within 30 days if they resided in a socioeconomically disadvantaged neighborhood, according to results from a recent retrospective cohort study.
Researchers evaluated data from a random sample of 255,744 Medicare beneficiaries who were discharged from 4,802 hospitals for congestive HF, acute MI or pneumonia from 2004 to 2009. The neighborhood socioeconomic disadvantage for each patient was measured at the census block group level via area deprivation index (ADI). Rates of 30-day and all-cause rehospitalization were determined from Medicare claims data.
Among patients in the 15% of neighborhoods with the greatest degree of disadvantage as indicated by ADI, risk for rehospitalization was significantly higher compared with patients in less disadvantaged neighborhoods. Rehospitalization rates did not differ significantly across less disadvantaged neighborhoods (mean, 21%); however, in the 15% of disadvantaged neighborhoods, rehospitalization rates increased with ADI across all evaluated diagnoses (range, 22% to 27%).
The observed association with socioeconomic disadvantage and rehospitalization risk persisted after adjustment for confounders. Risk also increased with ADI: Researchers observed an adjusted RR of 1.09 (95% CI, 1.05-1.12) for rehospitalization in the most disadvantaged 5% of neighborhoods; 1.07 (95% CI; 1.03-1.1) for the second-most disadvantaged neighborhoods; and 1.05 (95% CI 1.01-1.08) for the third-most disadvantaged 5% compared with the least disadvantaged 85% of neighborhoods. The researchers noted that this risk increase was similar to that observed in patients with chronic pulmonary disease (adjusted RR=1.06; 95% CI, 1.04-1.08), and greater than that observed in patients with diabetes (adjusted RR=0.95; 95% CI, 0.94-0.97).
Sensitivity analyses controlling for the hospital at which the patient was treated also indicated significant differences in rehospitalization risk according to ADI among otherwise similar patients.
“Residence within a disadvantaged US neighborhood is a rehospitalization predictor of magnitude similar to important chronic diseases,” the researchers concluded. “Measures of neighborhood disadvantage, such as the ADI, are easily created using data already routinely collected by the US government and freely available to the public and may be useful in targeting patient- and community-based initiatives designed to lower unwanted rehospitalization.”
Disclosure: One researcher reported receiving grants from the NIH and the John Hartford Foundation. Another reported receiving travel support/honoraria from the Massachusetts Hospital Association.
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