Table 1. Observed rates and unadjusted and adjusted odds of new institutionalizations by patient characteristics.
| Patient characteristic | N | Observed Rates | Unadjusted OR (95% CI) | Adjusted ORa (95% CI) |
|---|---|---|---|---|
| Overall | 597,986 | 10.0% | ||
| Race/ethnicity | ||||
| White | 524,253 | 9.7% | Reference | Reference |
| Black | 40,112 | 12.3% | 1.33 (1.27, 1.40) | 0.87 (0.79, 0.96) |
| Hispanic | 19,406 | 11.7% | 1.31 (1.27, 1.35) | 0.72 (0.61, 0.83) |
| Others | 14,215 | 12.5% | 1.23 (1.18, 1.29) | 0.83 (0.70, 0.99) |
| Sex | ||||
| Male | 190,505 | 9.3% | Reference | Reference |
| Female | 407,481 | 10.3% | 1.13 (1.11, 1.15) | 0.90 (0.86, 0.94) |
| Age, years | ||||
| 66-70 | 51,596 | 5.6% | Reference | Reference |
| 71-75 | 84,573 | 6.0% | 1.07 (1.02, 1.12) | 1.18 (1.01, 1.39) |
| 76-80 | 107,537 | 7.4% | 1.35 (1.29, 1.41) | 1.45 (1.24, 1.69) |
| 81-85 | 131,615 | 9.4% | 1.74 (1.67, 1.81) | 1.75 (1.51, 2.03) |
| 86-90 | 129,102 | 12.3% | 2.36 (2.26, 2.45) | 2.12 (1.83, 2.46) |
| ≥91 | 93,563 | 16.7% | 3.35 (3.22, 3.49) | 2.98 (2.55, 3.47) |
| Marital statusb | ||||
| Married | 211,357 | 6.8% | Reference | Reference |
| Unmarried | 373,767 | 11.8% | 1.85 (1.82, 1.89) | 1.30 (1.27, 1.34) |
| Medicaid eligibility | ||||
| No | 494,967 | 7.1% | Reference | Reference |
| Yes | 103,019 | 24.13% | 4.20 (4.12, 4.27) | 4.04 (3.79, 4.30) |
| Number of comorbidities | ||||
| 0,1 | 45,155 | 6.0% | Reference | Reference |
| 2 | 69,250 | 8.0% | 1.36 (1.29, 1.42) | 1.08 (1.01, 1.16) |
| 3 | 86,515 | 9.6% | 1.66 (1.59, 1.74) | 1.15 (1.07, 1.23) |
| 4 | 88,550 | 10.6% | 1.84 (1.76, 1.92) | 1.14 (1.06, 1.22) |
| ≥5 | 308,516 | 11.0% | 1.92 (1.84, 2.00) | 1.10 (1.04, 1.18) |
| Income quartilec | ||||
| ≤41,989 | 145,063 | 11.5% | Reference | Reference |
| 41,990-52,611 | 147,555 | 10.4% | 0.89 (0.87, 0.91) | 1.08 (1.01, 1.14) |
| 52,612-69,475 | 151,034 | 9.3% | 0.79 (0.77, 0.81) | 1.12 (1.05, 1.16) |
| ≥69,475 | 154,334 | 8.8% | 0.74 (0.72, 0.76) | 1.17 (1.10, 1.25) |
| Distance from SNF (km)d | ||||
| 0 | 162,578 | 11.8% | Reference | Reference |
| 0.1-7.1 | 135,250 | 8.5% | 0.69 (0.68, 0.71) | 0.69 (0.64, 0.75) |
| 7.2-15.7 | 150,252 | 9.0% | 0.74 (0.72, 0.76) | 0.76 (0.70, 0.83) |
| ≥15.8 | 149,906 | 10.4% | 0.87 (0.85, 0.89) | 0.85 (0.78, 0.92) |
| Length of hospital staye | ||||
| Quartile 1 | 227,124 | 8.8% | Reference | Reference |
| Quartile 2 | 150,731 | 10.6% | 1.23 (1.20, 1.26) | 0.94 (0.92, 0.97) |
| Quartile 3 | 103,251 | 10.5% | 1.21 (1.18, 1.24) | 0.95 (0.92, 0.98) |
| Quartile 4 | 116,880 | 11.1% | 1.29 (1.26, 1.32) | 1.04 (1.00, 1.07) |
| Type of DRG | ||||
| Surgical | 249,769 | 4.5% | Reference | Reference |
| Medical | 348,217 | 14.0% | 3.47 (3.40, 3.55) | 2.00 (1.94, 2.07) |
| Cognitive function | ||||
| Cognitively intact | 398,688 | 5.3% | Reference | Reference |
| Mildly impaired | 125,831 | 14.1% | 2.95 (2.88, 3.01) | 1.16 (0.99, 1.36) |
| Moderately or severely impaired | 73,467 | 28.6% | 7.21 (7.06, 7.36) | 1.59 (1.35, 1.89) |
| Mood | ||||
| No depression | 243,063 | 8.6% | Reference | Reference |
| Minimal or mild depression | 327,308 | 10.5% | 1.25 (1.23, 1.28) | 1.09 (1.04, 1.13) |
| Moderate or severe depression | 27,615 | 15.7% | 1.98 (1.91, 2.05) | 1.25 (1.14, 1.38) |
| ADL (score range 0-24) | ||||
| 0-6 | 25,595 | 3.4% | Reference | Reference |
| 7-12 | 138,442 | 4.5% | 1.32 (1.22, 1.41) | 0.99 (0.81, 1.20) |
| 13-18 | 388,478 | 10.4% | 3.25 (3.03, 3.47) | 1.38 (1.14, 1.67) |
| 19-24 | 45,471 | 27.2% | 10.48 (9.77, 11.24) | 2.31 (1.90, 2.80) |
| Hallucinations/Delusions | ||||
| No | 589,129 | 9.8% | Reference | Reference |
| Yes | 8,857 | 25.6% | 3.18 (3.03, 3.34) | 1.36 (1.28, 1.45) |
| Aggressive Behavior | ||||
| None | 561,798 | 9.2% | Reference | Reference |
| Moderate | 28,567 | 20.2% | 2.51 (2.43, 2.58) | 1.33 (1.29, 1.38) |
| Severe | 7,621 | 31.3% | 4.51 (4.29, 4.73) | 1.66 (1.55, 1.78) |
| Continent of bladder and bowel | ||||
| Yes | 306,092 | 4.6% | Reference | Reference |
| No | 291,894 | 15.6% | 3.82 (3.74, 3.89) | 1.85 (1.81, 1.89) |
| Ostomy | ||||
| No | 587,701 | 10.03% | Reference | Reference |
| Yes | 10,285 | 7.90% | 0.77 (0.72, 0.83) | 0.99 (0.92, 1.07) |
| Urinary catheter | ||||
| No | 546,538 | 9.60% | Reference | Reference |
| Yes | 51,448 | 14.18% | 1.56 (1.52, 1.60) | 1.26 (1.23, 1.30) |
| Insulin injection | ||||
| No | 486,857 | 9.9% | Reference | Reference |
| Yes | 111,129 | 10.6% | 1.08 (1.06, 1.10) | 1.01 (0.99, 1.04) |
| Pressure ulcer | ||||
| None | 528,169 | 9.4% | Reference | Reference |
| Any | 69,817 | 14.1% | 1.58 (1.54, 1.62) | 1.28 (1.21, 1.35) |
| Oxygen therapy | ||||
| No | 473,922 | 9.8% | Reference | Reference |
| Any | 124,064 | 10.6% | 1.08 (1.06, 1.11) | 0.89 (0.87, 0.92) |
| IV medication | ||||
| No | 558,084 | 10.1% | Reference | Reference |
| Yes | 39,902 | 7.9% | 0.76 (0.73, 0.79) | 0.74 (0.71, 0.77) |
Abbreviations: OR, odds ratio; CI, confidence interval; SNF, skilled nursing facility; DRG, Diagnosis-Related Group; ADL, activities of daily living; IV, intravenous.
Odds ratios are from a logistic regression model adjusted for all characteristics presented in the table, plus the Diagnosis-Related Group Major Diagnostic Categories (Supplementary Table S1), and state of residence. Also included in the model were a number of characteristics from the MDS with very low prevalence, including poor prognosis, cancer treatment, tracheostomy, ventilator, recent transfusion, dialysis and hospice care. The C statistic for the model was 0.83.
Marital status missing for 12,862 individuals.
Household income level in the beneficiary's zip code of residence, obtained from the 2013 American Community Survey (ACS) estimates of the U.S. Census Bureau.
Distance between individuals' zip code of residence and the skilled nursing facility.
Length of stay quartiles based on expected length of stay for admitting diagnosis-related group major diagnostic category (DRG-MDC).