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ZIP code may indicate mortality risk after hospital admission in type 2 diabetes
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A person with type 2 diabetes is more likely to die in the 6 months after hospital admission if he or she lives in a disadvantaged neighborhood, whereas a person with type 1 diabetes of low socioeconomic status is more likely to be readmitted to the hospital within 28 days, according to study data presented at the European Association for the Study of Diabetes annual meeting.
“We hope to use this work and other work to create a risk prediction tool that helps us target support to the patients being discharged who need it most,” Tim Robbins, MSc, a specialist registrar and clinical research fellow in diabetes and endocrinology at the Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom, told Endocrine Today. “I would argue that currently there is no reliable way to do this. The patient/public involvement work that I did before starting this project demonstrated that patients with diabetes, from across the country, feel the discharge process could be significantly improved with the right support.”
In a retrospective study, Robbins and colleagues analyzed electronic health record data over 3 years from 46,357 patients discharged from a large tertiary referral center with a diabetes diagnosis. Researchers matched data at the patient level to postcode sector socioeconomic data, extracted from Office of National Statistics Census and Population Density data sets. Researchers evaluated 19 socioeconomic variables, including index of multiple deprivation, employment, race, activity levels, unpaid care, language, and population and housing density. Outcome measures were 28-day readmission and 180-day mortality rates compared with prespecified diabetes cohorts.
Researchers found that socioeconomic status was associated with 14 of 19 socioeconomic variables in relation to 180-day mortality (P < .05) among patients with type 2 diabetes; however, there was no association between mortality and socioeconomic variables among patients with type 1 diabetes. Researchers found that strongest effect sizes were related to language, race and index of multiple deprivation.
In examining readmission rates, researchers observed that socioeconomic status was associated with only one of 19 variables for 28-day readmission among patients with type 2 diabetes vs. nine variables for patients with type 1 diabetes.
“Effect sizes in relation to socioeconomic status and readmission for type 1 diabetes cohorts [were] profound and strongest for deprivation indices and health-related activity impairment,” the researchers wrote in an abstract.
In a presentation, Robbins noted that geographic socioeconomic status has a “significant impact” on outcomes for people discharged from the hospital with a diagnosis of diabetes.
“Use of geographic postcode sector data can be readily incorporated into electronic health care systems and future risk models to enable personalized data-driven care, for example, more intensive or different models, or more intensive follow-up for those from areas of known deprivation,” the researchers said in a press release. – by Regina Schaffer
Reference:
Robbins T, et al. Abstract 818. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.
Disclosure: Robbins reports no relevant financial disclosures.
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David Kerr, MD, FRCPE, MD, FRCPE
This is a continuation of the story that tells us that having high rates of poor social conditions is a major predictor for diabetes in the first place. We also know that people who have low socioeconomic status, low income, low social support system and food insecurity fare much less well once they develop diabetes vs. people who have the opposite social circumstances, in terms of achieved levels of control and serious consequences. The cards are lined up against people with an excess burden of social determinants when it comes to the consequences of diabetes. We don’t quite understand what is going in terms of the physiology, but it is clear that when you are discharged to circumstances where there are high rates of crime, poverty and food deserts, then that is a very stressful place to be, and stress itself is a factor in diabetes outcomes.
There needs to be a revolution. In the UK, often the clinicians looking after people in hospital do not have an understanding of where the patient is being discharged. They may, in fact, feel powerless to make any change or have an assumption that primary care clinicians have the potential to influence patients. Even with all the technology today, the process for patients is fraught with bear traps, including poor or no communication, paper-based records and challenges in accessing primary care services immediately on discharge.
We need new ways of thinking about the discharge process to make it as seamless as possible and take into consideration where the patient is going.
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