Age trends in 30 day hospital readmissions: US national retrospective analysis

Abstract

ObjectiveTo assess trends in and risk factors for readmission to hospital across the age continuum.DesignRetrospective analysis.Setting and participants31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database.Main outcome measure30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group.ResultsThe 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile).ConclusionsThe likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.

Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data

“…The general patterns in the prevalence of SUDs and chronic conditions are consistent with prior studies (Gerteisetal.,2014; Ward and Schiller, 2013; Wu et al, 2015). The associations between SUDs and hospitalization by chronic condition status are in line with other studies of hospitalizations (Berry et al, 2018; Jiang et al, 2015). …”

“…Males and African American/Black patients (versus Caucasians/Whites) had elevated odds of tobacco, alcohol, and any drug use disorder. The results call for developing infrastructure support and training for primary care providers to assess and treat comorbid alcohol/drug use disorders and chronic conditions, especially among males, African American/Black patients, and adults with multiple chronic diseases (Berry et al, 2018; Hayes et al, 2016). …”

Vital Sign Abnormalities on Discharge Do Not Predict 30-Day Readmission

“…A recent study on 30-day hospital readmissions using Agency for Healthcare Research and Quality Nationwide Readmissions Database demonstrated that the presence of multiple chronic conditions had the highest odds of hospital readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). 29 This study also determined that mental health is one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th percentile). Furthermore, readmission rates vary significantly by type of insurance (private 7.0%, Medicaid 10.1%, and Medicare 16.4%).…”

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

“…These factors are less relevant in patients undergoing appendectomy. 66 There is wide variation in the rate of readmission postappendectomy among the included papers. This meta-analysis identified factors increasing these rates of readmission, such as complicated appendicitis, diabetes and open approach to surgery.…”

“…Berry and colleagues recently suggested in a retrospective analysis of over 31 million index hospital admission that readmission was associated with age between 16 and 20 years of age, associated chronic conditions, and mental health issues. These factors are less relevant in patients undergoing appendectomy …”