Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities. Methods A population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death. Results There were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01–1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk. Interpretation Socioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death.

Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease

“…Congestive heart failure (CHF) has been reported to be the most common readmission diagnosis after respiratory-based disease according to studies conducted in the United States, 8 , 9 and also one-fifth of COPD patients have been known to have unrecognized coexisting heart failure. 30 Unlike previous studies, 8 , 9 , 20 , 31 we reported that the cardiac reasons for readmission after AECOPD in Korea accounted for as little as 3% of patients. Nationwide data have shown that Korean COPD patients have a lower body mass index, lower comorbid hypertension and dyslipidaemia, which are known as risk factors for cardiac disease, and a lower prevalence of myocardial infarct than other races or ethnic groups.…”

Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

“…Previous COPD and non-COPD hospitalisations in the previous year also significantly increased the risk for 30-day readmission by 53% to 56% and 60% to 64%, respectively [38,39]. Consistent with other studies, GOTO et al [31] found that frequent exacerbators (defined as two hospitalisations in the past year) BOTTLE [21] GERSHON [32] GOTO [31] JACOBS [35] SHARIF [44] SIMMERING [45] TZY-CHYI YU [48] Overall (I 2 =95.4%, p=0.000) had a 2.5-fold increase in odds of readmission compared to non-frequent exacerbators. Disease severity of COPD was also a risk factor for readmission and has been evaluated using different tools.…”

“…An emergency room visit in the previous 6 months (1 versus 0) was associated with increased readmission risk with OR 1.90 (95% CI 1.01-3.58) in the study by BASHIR et al [19] and OR 1.25 (95% CI 1.21-1.29) in the study by HAKIM et al [33]. The risk of readmission increased with a greater number of previous emergency [19,32]. Previous COPD and non-COPD hospitalisations in the previous year also significantly increased the risk for 30-day readmission by 53% to 56% and 60% to 64%, respectively [38,39].…”

“…Alcohol use was the most frequently reported social risk factor in six papers [31,34,35,[44][45][46] and has been included in our meta-analysis. SINGH et al [46] and GERSHON et al [32] identified low socioeconomic status as a significant risk factor with a 22% and 6% increased risk of readmission, respectively.…”

“…Furthermore, in two studies [38,39], LOS ⩾14 days versus 1-2 days increased the relative risk of readmission 2.93-fold and 2.85-fold, respectively. GERSHON et al [32] found an OR of 1.18 when LOS was ⩾14 days compared to 4-6 days but found that this risk decreased to 66% and 37% when the LOS was 7-13 and 4-6 days, respectively [38]. RINNE et al [41] found that those with LOS of 3-4 days and >4 days had higher odds of readmission at 39% and twofold, respectively, compared to <3 days.…”