Appendix Table 1.
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) |
| Patient Comorbidity/Severity | |||||
| HCC Score Prior to Index Hospitalization Date |
1.12 (1.11, 1.13) | <0.001 | |||
| Comorbidities: | |||||
| Hypertension | 0.92 (0.9, 0.93) | <0.001 | |||
| Fluid and Electrolyte Disorders | 1.08 (1.06, 1.1) | <0.001 | |||
| Congestive Heart Failure | 1.16 (1.14, 1.18) | <0.001 | |||
| Chronic Pulmonary Disease | 1.06 (1.04, 1.08) | <0.001 | |||
| Deficiency Anemias | 1.09 (1.07, 1.11) | <0.001 | |||
| Diabetes, Uncomplicated | 0.95 (0.94, 0.97) | <0.001 | |||
| Diabetes, Complicated | 1.03 (1, 1.05) | 0.02 | |||
| Valvular Disease | 1.08 (1.06, 1.1) | <0.001 | |||
| Hypothyroidism | 1.03 (1.01, 1.05) | 0.01 | |||
| Peripheral Vascular Disease | 1.07 (1.05, 1.09) | <0.001 | |||
| Coagulopathy | 1 (0.97, 1.03) | 0.85 | |||
| Depression | 1.05 (1.02, 1.07) | <0.001 | |||
| Other Neurological Disorders | 0.98 (0.96, 1) | 0.09 | |||
| Obesity | 1.02 (0.99, 1.05) | 0.22 | |||
| Pulmonary Circulation Disease | 1.05 (1.02, 1.07) | <0.001 | |||
| Renal Failure | 1.11 (1.09, 1.14) | <0.001 | |||
| Weight Loss | 0.96 (0.93, 0.99) | 0.01 | |||
| Other Comorbidity | 1.03 (1.01, 1.05) | <0.001 | |||
| Length of Stay of Index Hospitalization: | |||||
| 2 Or Fewer Days | Ref | ||||
| 3–4 Days | 1.07 (1.04, 1.09) | <0.001 | |||
| 5–6 Days | 1.16 (1.13, 1.19) | <0.001 | |||
| 7 Or More Days | 1.34 (1.31, 1.37) | <0.001 | |||
| Discharged to a Skilled Nursing Facility: | |||||
| No | Ref | ||||
| Yes | 1.13 (1.11, 1.15) | <0.001 | |||
| Patient Demographics | |||||
| Age: | |||||
| 65–69 years | Ref | ||||
| 70–74 years | 1.01 (0.98, 1.05) | 0.38 | |||
| 75–79 years | 1.01 (0.98, 1.04) | 0.50 | |||
| 80–84 years | 1.01 (0.98, 1.05) | 0.36 | |||
| >=85 years | 0.99 (0.96, 1.02) | 0.42 | |||
| Gender: | |||||
| Male | Ref | ||||
| Female | 0.99 (0.97, 1) | 0.11 | |||
| Race: | |||||
| White | Ref | ||||
| Black | 1.06 (1.04, 1.09) | <0.001 | |||
| Other | 1 (0.96, 1.04) | 0.99 | |||
| Medicaid: | |||||
| No | Ref | ||||
| Yes | 1 (0.98, 1.02) | 0.82 | |||
| Disability: | |||||
| No | Ref | ||||
| Yes | 1.06 (1, 1.12) | 0.03 | |||
| Rural Urban Commuting Area (RUCA) for Patient Residence: |
|||||
| Urban Core Area | Ref | ||||
| Suburban Area | 1 (0.97, 1.03) | 0.91 | |||
| Large Town Area | 0.96 (0.94, 0.99) | 0.00 | |||
| Small Town and Isolated Rural Area | 1 (0.97, 1.03) | 0.97 | |||
| Index Hospital Characteristics | |||||
| Medical School Affiliation: | |||||
| None | Ref | ||||
| Minor | 1 (0.98, 1.02) | 0.73 | |||
| Major | 1.02 (1, 1.05) | 0.02 | |||
| Hospital Type: | |||||
| Non-Profit/Public | Ref | ||||
| For Profit | 1.01 (0.99, 1.03) | 0.34 | |||
| Average Annual Total Discharge Volume: | |||||
| Highest Tertile (12,576 Average Annual Discharges) |
Ref | ||||
| Middle Tertile (5,541 Average Annual Discharges) |
0.99 (0.97, 1.01) | 0.16 | |||
| Lowest Tertile (1,950 Average Annual Discharges) |
0.97 (0.95, 0.99) | 0.00 |
*
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.
†
Adjusted for all variables listed.
‡
Race data were missing for 291 patients. Index hospital medical school affiliation and for-profit status were missing for 777 patients.