title: Influence of neighborhood household income on early death or urgent hospital readmission.
abstract: BACKGROUND
  The relationship of socioeconomic status (SES) with hospital readmissions is unclear.
  
  
  METHODS
  We used population-based administrative datasets to randomly select 40,827 adult Ontarians discharged from hospital to the community. Patient postal codes were linked to average neighborhood household-income quintiles. The association of this SES measure with 30-day death or urgent readmission was measured after controlling for outcome risk using a validated index, LACE+: length of stay (L), acuity of the admission (A), comorbidity of the patient (measured with the Charlson Comorbidity Index score (C), and emergency-department use (E).
  
  
  RESULTS
  Within 1 month of discharge, 2638 (6.5%) people died or were urgently readmitted. Lower neighborhood income was significantly associated with both an increased outcome risk (P < 0.0001) and LACE+ score. After adjusting for LACE+ score, neighborhood income was no longer associated with 30-day death or urgent readmission (P = 0.21).
  
  
  CONCLUSIONS
  After accounting for known risk factors, early death or readmission is not more common in people from lower-income neighborhoods. Further study is required to determine if SES is associated with adverse postdischarge outcomes in settings without publicly funded healthcare.
authors.affiliation: Ottawa Hospital Research Institute and Institute for Clinical Evaluative Sciences, Ottawa, Canada. carlv@ohri.ca
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.forename: Jenna
authors.initials: J
authors.lastname: Wong
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000191:economics* / Q000639:trends; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007182:Income / Q000639:trends; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D011159:Population Surveillance / Q000379:methods; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class