The impact of patient socioeconomic status and other social factors on readmission: a prospective study in four Massachusetts hospitals.
Readmissions to hospitals may serve as markers for morbidity, high costs, and potentially poor quality of care, yet little is known about the relation of socioeconomic factors to the likelihood of readmission. In this article, we used logistic regression models to examine the readmission experience of nearly 12,000 patients, adjusting for age, gender, hospital, severity of illness, and the overall probability of readmission within each diagnosis related group (DRG). After adjustment, patients were more likely to be readmitted within 60 days if they were poor (OR = 1.25, p < .05), worked in unskilled or semiskilled occupations (OR = 1.25, p < .05), or rented their homes (OR = 1.23, p < .01). Nonwhites (OR = .76, p < .01) and uninsured patients (OR = .48, p < .01) were less likely to be readmitted. Within a 7-day period, patients who rented their homes were more likely to be readmitted (OR = 1.32), while patients were less likely to be readmitted if they were uninsured (OR = .36) or nonwhite (OR = .72) (all p < .05). Social support factors including marital status, living situation, and availability of help at home were not associated significantly with the risk of readmission. Our results suggest that patients in lower socioeconomic positions have higher readmission rates, at least for readmissions within longer time periods. Providers designing interventions to reduce the risk of readmission may want to target the groups identified by our study.
Weissman
J S
JS
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115.
Stern
R S
RS
Epstein
A M
AM
D003710:Demography; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome