Table 5.
Association Between Social Factors and Readmission in Heart Failure
| Social Factor | Variable Examined | Significant UV association/ UV analysis done | Significant MV association/ MV analysis done | MV Magnitude of Association‡ Ratio (95 % CI), p value |
|---|---|---|---|---|
| Level 1 Factors | ||||
| Age9–14,33–38,40–46,48,57,58,64–66,68–70,72–76 | 33 | 6/14 | 4/10 | 65–74 OR = 0.83 (0.75–0.91)40 |
| ≥80 OR = 4.1 (1.6–11), 0.00434 | ||||
| Age per year OR = 1.03 (1.012–1.05), 0.00233 | ||||
| Age per year OR = 1.05 (1.03–1.08)35 | ||||
| Age per year OR 1.17, 0.02136 | ||||
| >65yo OR = 1.45 (0.83–2.55), 0.2, (NS)14 | ||||
| 75–84 OR = 1.08 (1–1.16), (NS)42 | ||||
| ≥80 HR = 1.05 (0.99–1.12), 0.13, (NS)38 | ||||
| Age per year HR = 0.97 (0.92–1.02), (NS)13 | ||||
| Age per year HR = 1.03 (0.99–1.06), 0.117, (NS)74 | ||||
| Gender9–14,34–38,40–46,48,57,58,64–66,68–70,72,73,75 | 30 | 3/15 | 4/8 | Male OR = 1.12 (1.05–1.2)42 |
| Male OR = 1.37 (1.02–1.84), 0.0312 | ||||
| Male HR = 0.40 (0.16–0.96), 0.0443 | ||||
| Male OR = 1.00 (0.94–1.06), (NS)40 | ||||
| Male OR = 1.07 (0.66–1.74), 0.78, (NS)14 | ||||
| Male HR = 0.98 (0.94–1.02), 0.37, (NS)38 | ||||
| Male HR = 1.23 (0.64–2.36), (NS)13 | ||||
| Male rate ratio 1.2 (0.96–1.49), (NS)41 | ||||
| Race12,21,38,40,65,75,9–11,36,37,41–45,58,64,66,70,72 | 21 | 7/10 | 6/8 | Black OR = 1.04 (1.03–1.06), <0.00121 |
| Black OR = 1.28 (1.16–1.41)10 | ||||
| Black OR = 1.30 (1.22–1.39), 0.00019 | ||||
| Black HR = 1.24 (1.17–1.33), <0.00138 | ||||
| Black RR = 1.09 (1.06–1.13)37 | ||||
| Black OR = 1.05 (0.97–1.14), (NS)40 | ||||
| Non-white OR = 0.88 (0.78–1.01), (NS)42 | ||||
| not specified (no ratio, NS)65 | ||||
| Ethnicity39,70 | 2 | 1/1 | 1/1 | Hispanic OR = 1.11 (1.07–1.14), <0.00139 |
| Level 2 Factors | ||||
| Insurance9–12,14,57,65 | 7 | 3/4 | 3/4 | Medicaid OR = 1.74 (1.4–2.16), <0.0111 |
| Medicaid OR = 1.92 (1.57–2.36)10 | ||||
| Medicare OR = 1.59 (1.17–2.17), 0.00412 | ||||
| Medicare OR = 1.66 (1.38–2)10 | ||||
| Public insurance OR = 0.61 (0.34–1.07), 0.08, (NS)14 | ||||
| Marital Status12,14,36,43,46,69,73,75 | 8 | 1/4 | 2/3 | Not married OR = 1.28, 0.02136 |
| Single OR = 1.47 (1.08–2.01), 0.0212 | ||||
| Not married OR = 0.72 (0.45–1.15), 0.17, (NS)14 | ||||
| Mental Health12,14,33,77 | 5 | 2/4 | 2/5 | Depression OR = 1.44 (1–2.07), 0.05, (NS)12 |
| Depression OR = 1.21 (0.99–1.47), 0.06, (NS)47 | ||||
| Depression OR = 1.83 (0.93–3.57), 0.08, (NS)33 | ||||
| Depression OR = 1.14 (0.68–1.91), 0.62, (NS)14 | ||||
| Depression HR = 1.03 (0.98–1.09), 0.25, (NS)38 | ||||
| Anxiety OR = 0.97 (0.58–1.62), 0.87, (NS)14 | ||||
| Education13,36,65,73 | 4 | 0/0 | 0/2 | Lower Education OR 1.2, 0.11, (NS)36 |
| High School Graduate HR = 0.51 (0.25–1.02), (NS)13 | ||||
| Income36,44,46,75 | 4 | 1/3 | 1/2 | Lower Income OR = 1.18 (1.1–1.26), <0.000144 |
| Lower Income OR = 1.18, 0.06, (NS)36 | ||||
| Socioeconomic Status12,45,69 | 3 | 2/2 | 1/2 | Lower SES RR = 1.08 (1.03–1.12), <0.00145 |
| Lower SES OR = 1.3 (0.98–1.74), 0.08, (NS)12 | ||||
| Employment36,46,65 | 3 | 1/1 | 1/1 | Unemployed OR = 2.59 (1.22–5.48), 0.01346 |
| Level 3 Factors | ||||
| Social Environment | ||||
| Social Support13,48,64 | 3 | 1/2 | 1/2 | Higher Social Support HR = 0.93 (0.89–0.98), <0.00113 |
| Social Deprivation RR = 1.013 (0.94–1.1), 0.74, (NS)48 | ||||
| Living Status34,46,68 | 3 | 0/2 | 0/0 | N/A |
| Nursing home resident44 | 1 | 0/0 | 0/0 | N/A |
| Loneliness73 | 1 | 1/1 | 0/0 | N/A |
| No. of home address changes in prior year12 | 1 | 1/1 | 1/1 | More changes OR = 1.13 (1.07–1.19), <0.00112 |
| Behavioral | ||||
| Left Against Medical Advice10–12 | 3 | 1/1 | 0/0 | N/A |
| Smoking38,41,43,58,64,65,72 | 7 | 0/1 | 1/1 | Smoker HR = 1.07 (1.01–1.13), 0.0338 |
| Substance Abuse10,12 | 2 | 1/1 | 1/1 | Cocaine use OR = 1.78 (1.17–2.72), 0.0112 |
| Alcohol10 | 1 | 0/0 | 0/0 | N/A |
| Adherence w/follow-up visit12,14,65 | 3 | 2/2 | 1/2 | Missed appt. OR = 1.73 (1.06–2.8), 0.0314 |
| Missed appt. OR = 1.35 (0.99–1.83), 0.06, (NS)12 | ||||
| Medical adherence14 | 1 | 1/1 | 1/1 | Non-adherence OR = 1.72 (1.07–2.76), 0.0314 |
| Decline medical service14 | 1 | 1/1 | 1/1 | Decline OR = 1.75 (1.07–2.87), 0.0314 |
| Adherence to diet58,64 | 2 | 0/0 | 0/1 | Non-adherence OR = 0.94 (0.73–1.21), 0.62, (NS)58 |
| Medication adherence58,64 | 2 | 0/0 | 0/1 | Non-adherence OR = 1.03 (0.82–1.29), 0.8, (NS)58 |
| Sociocognitive | ||||
| English proficiency14 | 1 | 0/1 | 0/1 | Spanish OR = 0.97 (0.27–3.56), (NS)14 |
| Italian OR = 1.64 (0.31–8.6), (NS)14 | ||||
| Neighborhood | ||||
| Urban vs. Rural10,11,44,75 | 4 | 0/2 | 1/1 | Rural OR = 0.87 (0.78–0.98)10 |
UV univariate analysis, MV multivariate analysis, NH nursing home, N/A not applicable, NS not significant; ‡data reported varies based on information available in primary study, not all studies reported CI or p values