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Rich/Poor Divide Linked to Hospital Readmissions in Study

Posted: Feb 15, 2013 7:00 AM by Mary Elizabeth Dallas

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FRIDAY, Feb. 15 (HealthDay News) -- The divide between rich and poor in the state where you live may affect your risk of being readmitted to the hospital, according to a new report.

For the study, researchers looked at "income inequality," which they described as "the degree to which income is unevenly distributed within a society," and its impact on Medicare readmissions and deaths within 30 days of hospital discharge.

The researchers found that in states with the greatest income inequality, there were nearly 40,000 extra hospital readmissions over a three-year period in the United States. But they also found, in the report published online Feb. 15 in the BMJ, income inequality was not associated with an increased risk of death.

The study authors noted that the findings held true even after they adjusted for individual levels of income and education.

In conducting the study, researchers led by Dr. Peter Lindenauer, an associate professor of medicine at the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass., examined information on Medicare patients who had been admitted to the hospital due to a heart attack, heart failure or pneumonia.

For the study, the researchers' mortality (deaths) analyses included 2.7 million admissions to 4,500 hospitals, and their readmission analyses included 3.2 million admissions to 4,500 hospitals.

The investigators also analyzed data from the U.S. Census Bureau in order to compare the states with the three highest quarters of income inequality with the states in the lowest quarter.

Income inequality was not associated with an increased risk of death within 30 days for patients who had been admitted for a heart attack, heart failure or pneumonia, the study found. However, the findings revealed that patients exposed to greater levels of income inequality were at increased risk for readmission within 30 days of being discharged from the hospital. This was true for all three conditions.

For patients who had a heart attack or heart failure, the risk for readmission increased 1.5 percent. Those with pneumonia had a 1.4 percent higher risk. The researchers estimated this would amount to over 7,000 more readmissions for heart attack, nearly 18,000 more readmissions for heart failure and about 14,000 extra readmissions for pneumonia over three years.

It remains unclear why the investigators found no link between income inequality and the risk of death. They suggested in their report that over a 30-day period, "readmission is more sensitive to social conditions than is mortality, and that an effect on mortality might have been observed had we extended the period of observation to one year."

While the study found an association between distribution of wealth within a society and hospital readmissions, it did not prove a cause-and-effect relationship.

More research is needed to explain the findings, the authors pointed out in a journal news release.

More information

The U.S. Department of Health and Human Services has more about reducing unnecessary hospital readmissions.

SOURCE: BMJ, news release, Feb. 14, 2013

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