Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization
Abstract Background Clostridioides 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...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-020-05481-x |
| _version_ | 1818402564861853696 |
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| author | Elizabeth Scaria W. Ryan Powell Jen Birstler Oguzhan Alagoz Daniel Shirley Amy J. H. Kind Nasia Safdar |
| author_facet | Elizabeth Scaria W. Ryan Powell Jen Birstler Oguzhan Alagoz Daniel Shirley Amy J. H. Kind Nasia Safdar |
| author_sort | Elizabeth Scaria |
| collection | DOAJ |
| description | Abstract Background Clostridioides 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. Methods In 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. Results From 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]). Conclusions Residence 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. |
| first_indexed | 2024-12-14T08:10:22Z |
| format | Article |
| id | doaj.art-269cabeacfda47a7923c1740ed26e400 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-14T08:10:22Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-269cabeacfda47a7923c1740ed26e4002022-12-21T23:10:05ZengBMCBMC Infectious Diseases1471-23342020-10-0120111010.1186/s12879-020-05481-xNeighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalizationElizabeth Scaria0W. Ryan Powell1Jen Birstler2Oguzhan Alagoz3Daniel Shirley4Amy J. H. Kind5Nasia Safdar6Department of Industrial and Systems Engineering, University of Wisconsin-MadisonDivision of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public HealthDepartment of Biostatics & Medical Informatics, University of Wisconsin-Madison, School of Medicine and Public HealthDepartment of Industrial and Systems Engineering, University of Wisconsin-MadisonDivision of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public HealthDivision of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public HealthDivision of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public HealthAbstract Background Clostridioides 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. Methods In 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. Results From 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]). Conclusions Residence 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.http://link.springer.com/article/10.1186/s12879-020-05481-xClostridioides difficileSocioeconomic disadvantageSocial determinants of healthMedicare |
| spellingShingle | Elizabeth Scaria W. Ryan Powell Jen Birstler Oguzhan Alagoz Daniel Shirley Amy J. H. Kind Nasia Safdar Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization BMC Infectious Diseases Clostridioides difficile Socioeconomic disadvantage Social determinants of health Medicare |
| title | Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization |
| title_full | Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization |
| title_fullStr | Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization |
| title_full_unstemmed | Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization |
| title_short | Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization |
| title_sort | neighborhood disadvantage and 30 day readmission risk following clostridioides difficile infection hospitalization |
| topic | Clostridioides difficile Socioeconomic disadvantage Social determinants of health Medicare |
| url | http://link.springer.com/article/10.1186/s12879-020-05481-x |
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