1. Living in the most socioeconomically disadvantaged 15% of neighborhoods was linked to increased rate of rehospitalization for acute myocardial infarction, pneumonia and heart failure in Medicare patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Rehospitalization within 30 days of discharge occurs in about 20% of Medicare admissions and costs $17 billion annually. To better target programs that address readmissions toward high-risk patients, this retrospective study compared the area deprivation index (ADI) of ZIP codes to the rates of rehospitalization for 255,744 Medicare beneficiaries. The ADI describes the socioeconomic status of US ZIP codes based on the 2000 US census data. The average rehospitalization rate for most neighborhoods was 21%, while the most disadvantaged 15% of neighborhoods had rehospitalization rates from 22% to 27%. The risk of readmission associated with the ADI of a patient’s ZIP code was linked to a similar level of risk as having chronic pulmonary disease or peripheral vascular disease and was even greater than that of being on Medicaid or being diabetic. A limitation of this study was that ADIs were based on 2000 census data and the scoring may not reflect how the socioeconomic status of neighborhoods have changed. Overall, this study suggests that ADI may be used to identify patients who may benefit from interventions to reduce rehospitalizations.
Relevant Reading: Widening socioeconomic inequalities in US life expectancy, 1980–2000
In-Depth [retrospective cohort]: The study cohort consisted of 244,744 Medicare beneficiaries >65 years old hospitalized for myocardial infarction, pneumonia or heart failure. The patient characteristics and 30-day rehospitalization rates were compared to the ADI score, a multifactorial socioeconomic status indicator of the patients’ neighborhoods. Based on the percentiles of ADI scores, the risk of 30-day rehospitalization associated with living in the most disadvantaged 5% (RR 1.09, p<0.001), the 2nd most disadvantaged 5% (RR 1.07, p<0.001), and the 3rd most disadvantaged 5% (RR 1.05, p<0.01) of neighborhoods were significantly more than for people residing in the other 85%. The risk for rehospitalization associated with living in these disadvantaged neighborhoods was similar to those associated with chronic pulmonary disease (RR 1.06, p<0.001) or peripheral vascular disease (RR 1.07, p<0.001), and greater than the risks associated with being on Medicaid (RR 1.00, p<0.82) or having uncomplicated diabetes (RR 0.95, p <0.001).
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