Social Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions

Abstract

Social Determinants of Health and Their Effects on Readmission and 30-Day Readmission in Patients with a History of Cardiovascular Interventions Mark Delos Reyes, Baraka Muvuka, Jonathan Guerrero Indiana University School of Medicine- Northwest (IUSM-NW) Background: 30-day readmission is a quality indicator impacting patients and healthcare systems. Medicare patients accounted for 2.3 million 30-day readmissions, costing $35.7 billion 4 years following the 2012 Hospital Readmission Reduction Program (HRRP) launch . Three of six HRRP measures are cardiovascular: myocardial infarction, Heart Failure, and Coronary Artery Bypass Graft Surgery. This study examined relationships between social determinants of health (SDOH), demographics, and behavioral factors on readmission and 30-day readmission among patients with a cardiovascular intervention history in partnership with an urban Northwest Indiana (NWI)-based health system. Methods: This retrospective study analyzed de-identified data from inpatient SDOH screenings in Epic using the Protocol for Responding to and Assessing Patients Assets, Risks and Experiences (PRAPARE) at 3 urban hospitals between January 2021 and April 2024. Data analysis included descriptive, bivariate (Chi-Square, Mann-Whitney U, Kruskal Wallis; p<0.05), and multivariate (binary logistic regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample comprised 3717 patients, majority White (70.2%), publicly insured (87.4%), and older adults (73+17). Readmissions represented 43.5% of admissions, 19.8% being 30-day readmissions. Bivariate analysis revealed significant associations between readmission and age (p<0.001), ethnicity (p=0.001), race (p<0.001), sex (p<0.001), sexual orientation (p=0.007), insurance type (p<0.001), financial resource risk (<0.001), housing risk (p=0.05), smoking status (p=0.041), BMI (p<0.001), hospital (p<0.001), and comorbidities (p=0.027). Sex, insurance type, sexual orientation, BMI, and hospital were also associated with 30-day readmission. Multivariate analysis revealed significantly higher odds of readmission with prolonged hospital stay (OR=1.051; p<0.001), former smoking (OR=1.759; p=0.039), and patients at a small, lower SES-serving hospital (OR=1.473; p<0.001). Conclusions: Social-behavioral factors were associated with readmissions and 30-day readmissions among patients with a history of cardiovascular interventions. Integrating SDOH and behavioral screenings and interventions into hospital readmission reduction initiatives could strengthen these programs.