Social determinants of 30-day congestive heart failure readmissions: The weight of food insecurity

Abstract

Introduction Social determinants of health (SDOH) are drivers of chronic disease exacerbation and hospital readmissions. Congestive Heart Failure (CHF) is among 6 conditions targeted by the Centers for Medicare and Medicaid Services’ (CMS) Hospital Readmissions Reduction Program. In 2022, CHF represented 13.9% of all-cause deaths and cost $30.7 billion, with 30-day readmissions contributing to these costs. CMS mandates inpatient SDOH screenings and referrals, yet the impact of food insecurity in CHF readmissions remains understudied. This study examined the social determinants of 30-day CHF readmissions. Methods This study employed a participatory research approach and retrospective design to analyze an EHR-generated dataset of CHF hospitalizations from January 2021 to April 2024 across three urban hospitals in Northwest Indiana. The primary outcome was 30-day CHF readmissions. Independent variables included SDOH, demographics, health behaviors, and health outcomes. Descriptive, bivariate, and multivariate analyses (p<0.05) were conducted. Results The sample comprised 5,489 patients with CHF, 36.2% racial/ethnic minorities, 76.2% 65+ years old, and 91.8% publicly insured. The 30-day readmission rate was 22.4%. Bivariate analysis revealed significant associations between 30-day readmissions and ethnicity, sex, language, hospital, insurance type, food insecurity, and depression risk. Food insecurity remained significant (OR=2.128; p=0.033) in multivariate analysis. Discussion This study identified food insecurity as an upstream SDOH linked to 30-day readmissions in patients with CHF, emphasizing the need to address SDOH in acute care settings. This research has informed a partnership to develop food security interventions for patients with CHF, aimed at reducing readmissions and improving health outcomes.