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Low income linked to hospital readmissions

Nearly 40,000 readmissions linked to poverty

Jo Carlowe

Friday, 15 February 2013

A new study has linked income inequality to an increased risk of hospital readmission.

The study from the US published on bmj.com estimates that nearly 40,000 extra admissions to hospital were made as a result of this over the three year study period.

Income inequality is associated with a variety of adverse health outcomes, including higher infant mortality, reduced life expectancy, and poorer self-reported health. But little is known about the possible link between income inequality and outcome after admission to acute care hospitals.

So the researchers examined the association between income inequality and risk of death and readmission within 30 days of discharge from hospital.

They analysed data for US Medicare patients aged 65 years and older, hospitalised over a three year period (1 January 2006 to 31 December 2008) with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia.

Information on income inequality at state level was obtained from the US Census Bureau. US states in the three highest quarters of income inequality were compared with US states in the lowest quarter.

Several other state, hospital and patient level characteristics likely to influence the results were also taken into account.

Mortality analyses included 2.7 million admissions to 4,500 hospitals and readmission analyses included 3.2 million admissions to 4,500 hospitals.

Income inequality was not associated with an increased risk of death but patients exposed to higher levels of inequality did have an increased risk of readmission within 30 days of discharge.

This effect, say the authors, would translate to an increased risk of readmission of 1.5% for acute myocardial infarction and heart failure and 1.4% for pneumonia. Over the three year period, they estimate an excess of 7,153 readmissions for acute myocardial infarction, 17,991 for heart failure, and 14,127 for pneumonia.

Although no link was found between income inequality and mortality, the authors suggest this might have been seen had they extended the observation period of 30 days to a period of one year.

And they conclude that further research is needed “to elucidate the mechanisms underlying these observations.”

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