Age trends in 30 day hospital readmissions: US national retrospective analysis

Abstract

Objective: To assess trends in and risk factors for readmission to hospital across the age continuum.

Design: Retrospective analysis.

Setting and participants: 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database.

Main outcome measure: 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients' age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group.

Results: The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile).

Conclusions: The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.

Fig 1

Age trends in unadjusted, 30 day, unplanned readmission rates per 100 index hospital admissions

Fig 2

Age trends in adjusted likelihood of 30 day, unplanned hospital readmission. Reference group=age 45 years, midpoint in range of age. Multivariable odds ratios were adjusted for number of chronic conditions, sex, payer, reason for and severity of admission, type of admission (elective v emergent), length of stay, and discharge disposition

Fig 3

Variation in 30 day, unplanned hospital readmission by reason for index admission. X axis shows distributions of 30 day readmission rates across 314 reasons for index admission, distinguished with all patient-refined diagnosis related groups categories, for each age group. Rates were adjusted for sex, number of chronic conditions, severity of illness, type of admission (elective v emergent), length of stay, and discharge disposition. Midline of box is median rate by all patient-refined diagnosis related groups. Left and right borders of box are 25th and 75th centiles of rate by groups. Whiskers are minimum and maximum rates. Examples of most common reasons for index admissions within highest quarter (≥75th centile) of readmission rates are listed for each age category. IQR=interquartile range