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

BMC Infectious Diseases

Jen Birstler¹  Elizabeth Scaria²  Oguzhan Alagoz³  W. Ryan Powell⁴  Amy J. H. Kind⁵  Daniel Shirley⁶  Nasia Safdar⁷ 

[1] Department of Biostatics & Medical Informatics, University of Wisconsin-Madison, School of Medicine and Public Health, 201 WARF Building, 610 Walnut Street, 53726, Madison, WI, USA;Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 53706, Madison, WI, USA;Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 53706, Madison, WI, USA;Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, 707 WARF Building, 610 Walnut Street, 53726, Madison, WI, USA;Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, 53705, Madison, WI, USA;Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, 53705, Madison, WI, USA;Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, 53705, Madison, WI, USA;Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, 53705, Madison, WI, USA;Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, 53705, Madison, WI, USA;William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, 53705, Madison, WI, USA;

关键词: Clostridioides difficile;    Socioeconomic disadvantage;    Social determinants of health;    Medicare;   

DOI  :  10.1186/s12879-020-05481-x

来源: Springer

【 摘 要 】

BackgroundClostridioides 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.MethodsIn 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.ResultsFrom 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]).ConclusionsResidence 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.

【 授权许可】

CC BY