Table 3.
Risk of Rehospitalization Within 30 Days for Medicare Patients Discharged with Primary Diagnoses of Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia by Area Deprivation Index (ADI) Ranking of the Patient’s Neighborhood of Residence, 2004–2009 (N=255,744)*
| Characteristic | Unadjusted Risk Ratio (95% CI) |
P-Value | Adjusted† Risk Ratio (95% CI) |
P-Value | Predicted† Probability (95% CI) |
|---|---|---|---|---|---|
|
Area Deprivation Index (ADI) Grouping of the Patient’s Neighborhood of Residence |
|||||
| Least Disadvantaged 85% (Baseline Group), ADI Range = −52.63--113.44 |
1.00 | REF | 1.00 | REF | 0.21 (0.21, 0.21) |
| Third-Most Disadvantaged 5%, ADI Range = 113.45--115.12 |
1.05 (1.02, 1.09) | 0.003 | 1.05 (1.01, 1.08) | 0.01 | 0.22 (0.22, 0.23) |
| Second-Most Disadvantaged 5%, ADI Range = 115.13--117.46 |
1.09 (1.06, 1.13) | <0.001 | 1.07 (1.03, 1.1) | <0.001 | 0.23 (0.22, 0.23) |
| Most Disadvantaged 5%, ADI Range = 117.47--129.10 |
1.16 (1.12, 1.19) | <0.001 | 1.09 (1.05, 1.12) | <0.001 | 0.23 (0.22, 0.24) |
All models employ multivariate logistic regression methods to assess the relationship between ADI grouping and 30- day rehospitalization to produce risk ratios (using the methods of Kleinman and Norton (48)) and predicted probabilities.
All models adjusted for: Hierarchical Condition Category Score; indicator variables denoting the presence of comorbidities including hypertension, fluid and electrolyte disorders, congestive heart failure, chronic pulmonary disease, deficiency anemias, uncomplicated diabetes, complicated diabetes, valvular disease, hypothyroidism, peripheral vascular disease, coagulopathy, depression, other neurological disorders, obesity, pulmonary circulation disease, renal failure, weight loss and other comorbidity; length of stay of the index hospitalization; and an indicator variable for whether a patient was discharged to a skilled nursing facility; patient demographics including age, gender and race (White, Black or other), Medicaid status, disability status, Rural Urban Commuting Area (RUCA) for patient residence and index hospital characteristics including medical school affiliation, for-profit status and total discharge volume tertile. Race data were missing for 291 patients. Index hospital medical school affiliation and for-profit status were missing for 777 patients.