Social Determinants of Inequities in Neurodegenerative Disease Readmissions in Northwest Indiana: An Advocacy Opportunity

Abstract

Background: Neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, pose significant challenges given their progressive nature and multifaceted care needs. This research examined the intricate interplay between social determinants of health (SDOH) and hospital readmissions among individuals with neurodegenerative diseases. It is part of a Participatory Research partnership between Indiana University School of Medicine-Northwest and an urban health system in Northwest Indiana (NWI).

Methods: This retrospective study analyzed a dataset generated from routine SDOH screenings and referrals in Epic using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) for inpatient admissions from 3 NWI urban hospitals between January 2021 to April 2024. Data analysis was conducted in SPSS 29.0 with descriptive statistics, bivariate analysis (Chi-square), and multivariate analysis (binary logistic regression). This study received exemption from Indiana University Human Research Protection Program (IRB #14040).

Results: The sample consisted of 1,338 patients admitted for neurodegenerative diseases. Patients were predominantly older adults (73 ± 14), publicly insured (91.5%), and 31% racial/ethnic minorities. The bivariate analysis found that readmission was significantly associated with age (p<0.001), insurance type (p=0.003), hospital (p<0.001), physical activity level (0.034), and length of stay (p<0.001). After adjusting for these factors, the multivariate analysis found higher odds of hospital readmission among patients with public insurance (OR=76.1%; p=0.028), prolonged hospital stay (OR=8.5%; p<0.001), and within a small hospital in a medically underserved area (MUA) (OR=69.6%; p<0.001).

Conclusion: Understanding the impact of SDOH on hospital readmissions is crucial for developing multi-level interventions to reduce readmissions, inequities, and healthcare costs. Findings from this research underscore the critical need for policy advocacy and integrated approaches addressing SDOH as part of comprehensive readmission reduction programs. Examples of evidence-based approaches include improving access to quality neurodegenerative care in MUAs, increasing education on at-home neurodegenerative care, and comprehensive SDOH screenings and referrals.