Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19

• Type of Material: Article
• Authors: Zanthia Wiley, Emory University; Ambar Kulshreshtha, Emory University; Dong Li, Emory University; Julianne Kubes, Emory University; Sheetal Kandiah, Emory University; Serena Leung, Kaiser Permanente; Ketino Kobaidze, Emory University; Sangmin Ryan Shin, Kaiser Permanente; Abeer Moanna, Emory University; Jonathan Perkins, Emory University; Matthew Hogan, Emory University; Kanika Sims, Morehouse School of Medicine; Tolu Amzat, Emory University; Valeria D. Cantos, Emory University; Temitope Elutilo-Ayoola, Morehouse School of Medicine; Jasmah Hanna, Emory University; Nadine Harris, Emory University; Tracey Henry, Emory University; Onyinye Iheaku, Emory University; Mariam Japaridze, Wayne State University; Vaishnavi Lanka, Emory University; Theresa A. Johnson, Atlanta VA Health Care System; Nkechi Mbaezue, Morehouse School of Medicine; Paulina Rebolledo, Emory University; Marybeth Sexton, Emory University; Phani Keerthi Surapaneni, Morehouse School of Medicine; Nicole Franks, Emory University
• Language: English
• Date: 2022-08-01
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © American Federation for Medical Research 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/jim-2022-002344
• Title of Journal or Parent Work: JOURNAL OF INVESTIGATIVE MEDICINE
• Volume: 70
• Issue: 6
• Start Page: 1406
• End Page: 1415
• Grant/Funding Information: ZW, AK, DL, SK, KK, SRS, AM, JP, KMS, TA, VCL, JH, NMH, TLH, OI, NM, PAR, MES, and NF received grant support from the Woodruff Health Sciences Center for Urgent Research Engagement (CURE Grant) made possible by the philanthropic support from the O. Wayne Rollins Foundation and the William Randolph Hearst Foundation.
• Keywords: COVID-19; hospitals
• Research Categories: Biology, Virology; Health Sciences, Health Care Management

Abstract

COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.