Economic, Sociodemographic Factors Affect COPD Hospitalization Readmission

Patients who experience acute exacerbation of chronic obstructive pulmonary disease (AECOPD)who earn less than $38,000 per year, are male, and are treated at urban hospitals have a higher risk of being readmitted to a hospital within a month of discharge, according to new research.

In the recent BMC Public Health article, researchers found that sociodemographic and economic factors were associated with increased readmissions for patients treated for AECOPD, heart failure, pneumonia and acute myocardial infarction.

University of Buffalo researchers reviewed data on more than 19.2 million hospital admissions and more than 3.6 million readmissions within 30 days, which accounted for nearly half of U.S. hospitalizations during the period. Thirty-day readmission rates were assessed in relation to three sociodemographic and economic characteristics: gender, household income, and the location of the hospital in an urban or rural setting.

They found that patients who were female, had higher household income, and received treatment at rural hospitals were associated with decreased odds of

30-day readmission for AECOPD and the other health conditions.

The study also found that patients ages 75 to 90 accounted for the highest percentage of readmissions, except for those treated for AECOPD. In that group, those who were ages 40 to 64 had the highest readmission rates.

“Evidence suggests that up to 80% of a patient’s health outcomes are a result of social, behavioral and economic factors rather than their medical care,” said lead investigator David Jacobs, Pharm.D., Ph.D., assistant professor of pharmacy practice in the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, in a news release.

“Social and economic disparities will continue to play an important role in patient care and health outcomes. Current readmission policy does not adequately account for patient sociodemographic factors, which may further drive health inequity,” Jacobs added.

AECOPDs are responsible for up to 70% of COPD-related healthcare costs, according to a 2019 study in Current Opinion Pulmonary Medicine. Hospital readmissions alone accounted for more than $15 billion in direct costs annually, the researchers said.

Early hospital readmissions remain common in the US, particularly within the Medicare population, according to Jacobs. Plus, social risk factors that impact health outcomes are disproportionately represented in high-needs populations, he said.

Part of the challenge with Medicare patient readmission is that hospitals that exceed expected 30-day readmission rates are fined by the CMS’ Hospital Readmission Reduction Program (HRRP). These policies penalize hospitals in low socioeconomic areas and safety net hospitals, which serve medically and socially vulnerable patients and consequently have higher 30-day readmission rates, according to Jacobs.

“Providers and hospitals recognize the association of social needs with patient outcomes, yet they may be reluctant to assume responsibility for a patient’s social-related needs given their complexity coupled with increasing clinical demands,” Jacobs said. “Hospitals should not be penalized for treating higher risk patients when social risks are outside a hospital’s control.”

Patients with a lower household income may have more difficulties affording prescriptions or accessing transportation to follow-up appointments, he adds.

However, findings on the relationship between hospital location and readmission rates are conflicting, Jacobs said. Patients who need surgery or require additional resources, such as treatment by a specialist, are often referred to urban hospitals.

“Urban hospitals, therefore, may be associated with higher odds of 30-day readmission because they see complex patients from both urban and rural areas,” he noted.

“Policy change, innovative care delivery models, and community-level interventions that address social and economic needs beyond the hospital should be explored and tested to mitigate hospital readmissions and minimize health inequity,” Jacobs said.