Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study | Journal Scan

Study Questions:

What is the association between area deprivation index (ADI), a composite measure of neighborhood socioeconomic disadvantage, and 30-day rehospitalization rates for patients discharged with congestive heart failure, pneumonia, or myocardial infarction?

Methods:

This was a retrospective cohort study of a random 5% national sample of Medicare patients discharged with congestive heart failure, pneumonia, or myocardial infarction between 2004 and 2009 (n = 255,744). An ADI was calculated for each US census block. Logistic regression was used to assess the relationship between ADI grouping and 30-day rehospitalization all-cause readmission rate.

Results:

Across the least disadvantaged 85% of neighborhoods, the average 30-day rehospitalization rate was 21% and did not vary significantly. However, residence within the most disadvantaged 15% of neighborhoods was associated with an increased risk for 30-day hospitalization from 22% to 27% across all three primary diagnoses. Residence within the most disadvantaged 15% of neighborhoods was an independent predictor of readmission with a risk ratio similar to that of chronic pulmonary disease and peripheral vascular disease (and greater than that associated with having diabetes or being on Medicaid).

Conclusions:

The authors concluded that residence in a severely disadvantaged neighborhood is an independent predictor of 30-day all-cause readmission.

Perspective:

This is an interesting study that draws attention to significant neighborhood socioeconomic disadvantage as a predictor of 30-day all-cause readmission for patients discharged from an index hospitalization for congestive heart failure, pneumonia, or myocardial infarction (discharge diagnoses for which there may be hospital-based Medicare payment penalties). Although there is no consensus on how to measure disadvantage and this particular study was limited by its administrative data not including information on quality of care or access, the authors’ findings suggest the potential value of considering more intensive transitional care services for particularly disadvantaged populations/neighborhoods.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Censuses, Heart Failure, Hospitalization, Vulnerable Populations, Medicare, Myocardial Infarction, Pneumonia, Residence Characteristics


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