Readmissions Among Patients Admitted With Acute Decompensated Heart Failure Based on Income Quartiles

Shantanu Patil, Mahek Shah, Brijesh Patel, Manyoo Agarwal, Pradhum Ram, Venkata Mahesh Alla

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)1939-1950
Number of pages12
JournalMayo Clinic Proceedings
Volume94
Issue number10
DOIs
StatePublished - Oct 2019

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Patient Readmission
Heart Failure
Social Adjustment
Costs and Cost Analysis
Social Class
Health Care Costs
Cohort Studies
Multivariate Analysis
Odds Ratio
Databases

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 journalArticle

Patil, Shantanu ; Shah, Mahek ; Patel, Brijesh ; Agarwal, Manyoo ; Ram, Pradhum ; Alla, Venkata Mahesh. / Readmissions Among Patients Admitted With Acute Decompensated Heart Failure Based on Income Quartiles. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 10. pp. 1939-1950.
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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.",
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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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