Socioeconomic status as an independent risk factor for hospital readmission for heart failure
The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income...
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| Veröffentlicht in: | The American journal of cardiology 2001-06, Vol.87 (12), p.1367-1371 |
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| container_title | The American journal of cardiology |
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| creator | Philbin, Edward F Dec, G.William Jenkins, Paul L DiSalvo, Thomas G |
| description | The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p |
| doi_str_mv | 10.1016/S0002-9149(01)01554-5 |
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The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square test for trend across all quartiles; p <0.0001 for comparison between quartiles 1 and 4). After adjustment for baseline differences and process of care, income remained a significant predictor, with an increase in the risk of readmission noted in association with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18; 95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients hospitalized for treatment of heart failure in New York differ from higher income patients in important clinical and demographic comparisons. Even after adjustment for these fundamental differences and other potential confounding factors, lower income is a positive predictor of readmission risk.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(01)01554-5</identifier><identifier>PMID: 11397355</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Black or African American ; Black People ; Cardiology. Vascular system ; Comorbidity ; Female ; Health risk assessment ; Heart ; Heart failure ; Heart Failure - epidemiology ; Heart Failure - therapy ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Hospitalization ; Hospitals, Rural - statistics & numerical data ; Humans ; Male ; Medicaid - statistics & numerical data ; Medical sciences ; Middle Aged ; New York - epidemiology ; Patient Readmission - statistics & numerical data ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; White People</subject><ispartof>The American journal of cardiology, 2001-06, Vol.87 (12), p.1367-1371</ispartof><rights>2001 Excerpta Medica Inc.</rights><rights>2001 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Jun 15, 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-8bf75495bcfc58e0a806210f2a18f316475f951c6b8529b12a46e5eb7e9c7e43</citedby><cites>FETCH-LOGICAL-c469t-8bf75495bcfc58e0a806210f2a18f316475f951c6b8529b12a46e5eb7e9c7e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0002-9149(01)01554-5$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1039271$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11397355$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Philbin, Edward F</creatorcontrib><creatorcontrib>Dec, G.William</creatorcontrib><creatorcontrib>Jenkins, Paul L</creatorcontrib><creatorcontrib>DiSalvo, Thomas G</creatorcontrib><title>Socioeconomic status as an independent risk factor for hospital readmission for heart failure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square test for trend across all quartiles; p <0.0001 for comparison between quartiles 1 and 4). After adjustment for baseline differences and process of care, income remained a significant predictor, with an increase in the risk of readmission noted in association with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18; 95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients hospitalized for treatment of heart failure in New York differ from higher income patients in important clinical and demographic comparisons. Even after adjustment for these fundamental differences and other potential confounding factors, lower income is a positive predictor of readmission risk.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Black or African American</subject><subject>Black People</subject><subject>Cardiology. Vascular system</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - therapy</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Hospitalization</subject><subject>Hospitals, Rural - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medicaid - statistics & numerical data</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>New York - epidemiology</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Socioeconomic Factors</subject><subject>White People</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1rFTEUhkOxtLcfP6EyiIgupuZMJslkJVKqFgpdtFsJmcwJpp2bXJOM4L9v2nvR4kbIByHPeXl5CDkDeg4UxMdbSmnXKujVewofKHDet3yPrGCQqgUF7BVZ_UEOyVHO9_UJwMUBOQRgSjLOV-T7bbQ-oo0hrr1tcjFlyY2pKzQ-TLjBeoTSJJ8fGmdsialxdf-IeeOLmZuEZlr7nH0M2w80qVTSz0vCE7LvzJzxdHcfk7svl3cX39rrm69XF5-vW9sLVdphdJL3io_WWT4gNQMVHVDXGRgcA9FL7hQHK8aBd2qEzvQCOY4SlZXYs2Pybhu7SfHngrno2sjiPJuAcclaUgUdk6KCb_4B7-OSQq2mO0bZAELKCvEtZFPMOaHTm-TXJv3WQPWTe_3sXj-J1RT0s3vN69zrXfgyrnH6O7WTXYG3O8Bka2aXTLA-v0hnqpNQsU9bDKuxXx6TztZjsDj5hLboKfr_NHkEHQigKQ</recordid><startdate>20010615</startdate><enddate>20010615</enddate><creator>Philbin, Edward F</creator><creator>Dec, G.William</creator><creator>Jenkins, Paul L</creator><creator>DiSalvo, Thomas G</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20010615</creationdate><title>Socioeconomic status as an independent risk factor for hospital readmission for heart failure</title><author>Philbin, Edward F ; Dec, G.William ; Jenkins, Paul L ; DiSalvo, Thomas G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-8bf75495bcfc58e0a806210f2a18f316475f951c6b8529b12a46e5eb7e9c7e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Black or African American</topic><topic>Black People</topic><topic>Cardiology. Vascular system</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - therapy</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Hospitalization</topic><topic>Hospitals, Rural - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medicaid - statistics & numerical data</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>New York - epidemiology</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Socioeconomic Factors</topic><topic>White People</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Philbin, Edward F</creatorcontrib><creatorcontrib>Dec, G.William</creatorcontrib><creatorcontrib>Jenkins, Paul L</creatorcontrib><creatorcontrib>DiSalvo, Thomas G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Philbin, Edward F</au><au>Dec, G.William</au><au>Jenkins, Paul L</au><au>DiSalvo, Thomas G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Socioeconomic status as an independent risk factor for hospital readmission for heart failure</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2001-06-15</date><risdate>2001</risdate><volume>87</volume><issue>12</issue><spage>1367</spage><epage>1371</epage><pages>1367-1371</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square test for trend across all quartiles; p <0.0001 for comparison between quartiles 1 and 4). After adjustment for baseline differences and process of care, income remained a significant predictor, with an increase in the risk of readmission noted in association with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18; 95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients hospitalized for treatment of heart failure in New York differ from higher income patients in important clinical and demographic comparisons. Even after adjustment for these fundamental differences and other potential confounding factors, lower income is a positive predictor of readmission risk.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11397355</pmid><doi>10.1016/S0002-9149(01)01554-5</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Biological and medical sciences Black or African American Black People Cardiology. Vascular system Comorbidity Female Health risk assessment Heart Heart failure Heart Failure - epidemiology Heart Failure - therapy Heart failure, cardiogenic pulmonary edema, cardiac enlargement Hospitalization Hospitals, Rural - statistics & numerical data Humans Male Medicaid - statistics & numerical data Medical sciences Middle Aged New York - epidemiology Patient Readmission - statistics & numerical data Risk Factors Sex Factors Socioeconomic Factors White People |
| title | Socioeconomic status as an independent risk factor for hospital readmission for heart failure |
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