Influence of neighborhood household income on early death or urgent hospital readmission

Abstract

Background: The relationship of socioeconomic status (SES) with hospital readmissions is unclear.

Methods: We used population-based administrative datasets to randomly select 40,827 adult Ontarians discharged from hospital to the community. Patient postal codes were linked to average neighborhood household-income quintiles. The association of this SES measure with 30-day death or urgent readmission was measured after controlling for outcome risk using a validated index, LACE+: length of stay (L), acuity of the admission (A), comorbidity of the patient (measured with the Charlson Comorbidity Index score (C), and emergency-department use (E).

Results: Within 1 month of discharge, 2638 (6.5%) people died or were urgently readmitted. Lower neighborhood income was significantly associated with both an increased outcome risk (P < 0.0001) and LACE+ score. After adjusting for LACE+ score, neighborhood income was no longer associated with 30-day death or urgent readmission (P = 0.21).

Conclusions: After accounting for known risk factors, early death or readmission is not more common in people from lower-income neighborhoods. Further study is required to determine if SES is associated with adverse postdischarge outcomes in settings without publicly funded healthcare.