The Association of Socioeconomic Status and Discharge Destination with 30-Day Readmission after Ischemic Stroke |
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| Affiliation: | 1. Department of Neurology, Neurological Institute, Cleveland Clinic, United States;2. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, United States;3. Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States;1. Department of Anesthesiology, Division of Neurological Anesthesia, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 19107;2. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA, 19107;1. Center for Outcomes Research, Houston Methodist, Houston, TX, United States;2. University of Texas Southwestern at Dallas, United States;3. Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States;1. Department of MRI, Shaanxi Provincial People''s Hospital, Xi''an, China;2. Department of Radiology, Tangdu Hospital, the Military Medical University of PLA Airforce (Fourth Military Medical University), Xi''an 710038, Shaanxi, PR China;1. School of Medicine (School of Nursing), Nantong University, No. 19 Qixiu Road, Nantong, Jiangsu 226000, China;2. Department of Gerontology, Nantong Third People''s Hospital, Nantong University, #60 Youth Middle Road, Chongchuan District, Nantong, Jiangsu 226006, China;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;3. Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota;4. Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota;6. Division of Neurology, Mayo Clinic, Rochester, Minnesota;5. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | ObjectivesThis study aimed to explore the association of socioeconomic status and discharge destination with 30-day readmission after ischemic stroke.Materials and MethodsWe examined 30-day all-cause readmission among patients hospitalized for ischemic stroke in states of Arkansas, Iowa, and Wisconsin in 2016 and 2017 and New York in 2016 using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases.ResultsAmong the 52301 patients included, 51.1% were female. The 30-day readmission rates were 10.2%, 8.2%, 9.3%, 10.4%, 11.6%, and 11.2% for age group 18-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years, respectively (p<0.001). In Generalized Estimating Equation analysis, patients with Medicare and Medicaid insurance were more likely to be readmitted, compared with private insurance, (adjusted Odds Ratio [aOR] 1.37, 95% CI 1.23-1.53; and aOR 1.26, 95% CI 1.09-1.45, respectively). Patients in the bottom quartile of zip code level median household income had higher 30-day readmission rate (12.4%) than those in the 2nd, 3rd and 4th quartile (10.3%, 10.1%, and 10.7%, respectively, p<0.001). Compared with those discharged home with self-care which had the lowest readmission rate (8.4%), patients who left against medical advice had the highest readmission rate (18.6%; aOR 2.23, 95% CI 1.75-2.83), followed by rehabilitation and skilled nursing facilities (13.2%; aOR 1.33, 95% CI 1.22-1.46), and home with home health care (11.3%, aOR 1.18, 95% CI 1.08-1.28).ConclusionsSocioeconomic status and discharged destination affect readmission after stroke. These results provide evidence to inform vulnerable patient population as targets for readmission prevention. |
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