Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

Abstract

Background Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as ‘neighborhood’ socioeconomic disadvantage, on a CDI patient’s health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient’s ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. Methods In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. Results From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). Conclusions Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.

Disparities in Successful Discharge to the Community Following Use of Medicare Home Health by Level of Neighborhood Socioeconomic Disadvantage

“…We found that patients in the most disadvantaged neighborhoods were more likely to be racial/ethnic minorities, report worse health status, and live alone than those in less disadvantaged neighborhoods. Also, consistent with previous studies on other care settings (Bhavsar et al, 2018; Kind et al, 2014; Nacht et al, 2022; Scaria et al, 2020), we found that patients living in less disadvantaged neighborhoods were associated with better home health outcomes than those in the most disadvantaged neighborhoods. Our findings suggest that, for Medicare beneficiaries, remaining in the community and home through home health care is more challenging in the most disadvantaged neighborhoods than in less disadvantaged neighborhoods.…”

“…Our findings align with previous studies on neighborhood context. Several studies have shown that people in more disadvantaged neighborhoods are associated with worse health outcomes than their counterparts in less disadvantaged neighborhoods (Bhavsar et al, 2018; Kind et al, 2014; Nacht et al, 2022; Scaria et al, 2020). For example, Kind and colleagues have shown that living in the most disadvantaged neighborhoods is associated with a higher risk of hospital readmission among Medicare patients discharged with congestive heart failure, pneumonia, or myocardial infarction (Kind et al, 2014).…”

Risk factor for 31-day unplanned readmission to hospital in patients with pulmonary tuberculosis in China

“… 11 In addition, comorbidities and socioeconomic factors were also considered to be associated with readmission. 12 , 13 So far, readmissions for major disease and surgical diagnoses have been studied, but the risk factors for early unplanned readmission among patients with pulmonary TB without research. Thus, this study aimed to investigate risk factors associated with 31-day unplanned readmission of patients previously discharged with pulmonary TB in China.…”

Patient Experiences with Clostridioides difficile Infection and Its Treatment: A Systematic Literature Review

“…Approximately 20-27% of all CDI cases are community associated with an incidence rate of 20-30 per 100,000 population across the USA, Europe, and Canada [2]. Patients with recurrent CDI (rCDI) face dire clinical sequelae, including poorer prognosis and higher complication rates [8][9][10][11][12][13]. CDI is rated as an urgent antibiotic threat by the US Centers for Disease Control and Prevention [3].…”