Abstract
Objective: To determine the impact of socioeconomic status using median household income within the patient's community on rate of readmission among patients with heart failure (HF). Patients and Methods: We derived a study cohort of patients who were admitted from January 1, 2013, through December 31, 2014, with congestive HF from the Healthcare Cost and Utilization Project National Readmission Database. Patients were stratified into quartiles according to the estimated median household income of residents in the patient's ZIP Code (quartile 1, lowest; quartile 4, highest). The primary outcome was 30-day readmission. We used univariate and multivariate models to compare patients with respect to baseline characteristics, income quartiles, and 30-day readmission. Results: About 20% (110,152 of 546,841) of patients with an index HF admission were readmitted within the first 30 days. Patients in the lowest income quartile had a higher readmission rate compared with those in the highest income quartile (21.1% [35,422 of 167,625] vs 19.5% [20,771 of 106,353]; P<.001). Patients within the lowest income group had higher odds of readmission for cardiovascular causes compared with the highest income group (50.6% [17,923 of 35,422] vs 48.8% [10,136 of 20,771; P<.001). Readmissions within the lowest income group accounted for 30% of all rehospitalization-related costs at $715 million. Multivariate analysis confirmed a higher rate of 30-day readmission among patients in the lowest income group compared with those in the highest group (adjusted odds ratio, 1.11; 95% CI, 1.08-1.13). Conclusion: Our study shows that patients in communities with the lowest quartile of income have a higher rate of readmission following the index HF admission with high associated costs. Readmission reporting and reimbursement adjustments should account for these socioeconomic inequalities.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1939-1950 |
| Number of pages | 12 |
| Journal | Mayo Clinic Proceedings |
| Volume | 94 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2019 |
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All Science Journal Classification (ASJC) codes
- Medicine(all)
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Readmissions Among Patients Admitted With Acute Decompensated Heart Failure Based on Income Quartiles. / Patil, Shantanu; Shah, Mahek; Patel, Brijesh; Agarwal, Manyoo; Ram, Pradhum; Alla, Venkata Mahesh.
In: Mayo Clinic Proceedings, Vol. 94, No. 10, 10.2019, p. 1939-1950.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Readmissions Among Patients Admitted With Acute Decompensated Heart Failure Based on Income Quartiles
AU - Patil, Shantanu
AU - Shah, Mahek
AU - Patel, Brijesh
AU - Agarwal, Manyoo
AU - Ram, Pradhum
AU - Alla, Venkata Mahesh
PY - 2019/10
Y1 - 2019/10
N2 - Objective: To determine the impact of socioeconomic status using median household income within the patient's community on rate of readmission among patients with heart failure (HF). Patients and Methods: We derived a study cohort of patients who were admitted from January 1, 2013, through December 31, 2014, with congestive HF from the Healthcare Cost and Utilization Project National Readmission Database. Patients were stratified into quartiles according to the estimated median household income of residents in the patient's ZIP Code (quartile 1, lowest; quartile 4, highest). The primary outcome was 30-day readmission. We used univariate and multivariate models to compare patients with respect to baseline characteristics, income quartiles, and 30-day readmission. Results: About 20% (110,152 of 546,841) of patients with an index HF admission were readmitted within the first 30 days. Patients in the lowest income quartile had a higher readmission rate compared with those in the highest income quartile (21.1% [35,422 of 167,625] vs 19.5% [20,771 of 106,353]; P<.001). Patients within the lowest income group had higher odds of readmission for cardiovascular causes compared with the highest income group (50.6% [17,923 of 35,422] vs 48.8% [10,136 of 20,771; P<.001). Readmissions within the lowest income group accounted for 30% of all rehospitalization-related costs at $715 million. Multivariate analysis confirmed a higher rate of 30-day readmission among patients in the lowest income group compared with those in the highest group (adjusted odds ratio, 1.11; 95% CI, 1.08-1.13). Conclusion: Our study shows that patients in communities with the lowest quartile of income have a higher rate of readmission following the index HF admission with high associated costs. Readmission reporting and reimbursement adjustments should account for these socioeconomic inequalities.
AB - Objective: To determine the impact of socioeconomic status using median household income within the patient's community on rate of readmission among patients with heart failure (HF). Patients and Methods: We derived a study cohort of patients who were admitted from January 1, 2013, through December 31, 2014, with congestive HF from the Healthcare Cost and Utilization Project National Readmission Database. Patients were stratified into quartiles according to the estimated median household income of residents in the patient's ZIP Code (quartile 1, lowest; quartile 4, highest). The primary outcome was 30-day readmission. We used univariate and multivariate models to compare patients with respect to baseline characteristics, income quartiles, and 30-day readmission. Results: About 20% (110,152 of 546,841) of patients with an index HF admission were readmitted within the first 30 days. Patients in the lowest income quartile had a higher readmission rate compared with those in the highest income quartile (21.1% [35,422 of 167,625] vs 19.5% [20,771 of 106,353]; P<.001). Patients within the lowest income group had higher odds of readmission for cardiovascular causes compared with the highest income group (50.6% [17,923 of 35,422] vs 48.8% [10,136 of 20,771; P<.001). Readmissions within the lowest income group accounted for 30% of all rehospitalization-related costs at $715 million. Multivariate analysis confirmed a higher rate of 30-day readmission among patients in the lowest income group compared with those in the highest group (adjusted odds ratio, 1.11; 95% CI, 1.08-1.13). Conclusion: Our study shows that patients in communities with the lowest quartile of income have a higher rate of readmission following the index HF admission with high associated costs. Readmission reporting and reimbursement adjustments should account for these socioeconomic inequalities.
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UR - http://www.scopus.com/inward/citedby.url?scp=85072376434&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2019.05.027
DO - 10.1016/j.mayocp.2019.05.027
M3 - Article
C2 - 31585578
AN - SCOPUS:85072376434
VL - 94
SP - 1939
EP - 1950
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
SN - 0025-6196
IS - 10
ER -