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. 2022 Aug;70(6):1406-1415.
doi: 10.1136/jim-2022-002344. Epub 2022 Jun 1.

Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19

Zanthia Wiley  1 , Ambar Kulshreshtha  2 , Dong Li  3 , Julianne Kubes  4 , Sheetal Kandiah  5 , Serena Leung  6 , Ketino Kobaidze  3 , Sangmin Ryan Shin  6 , Abeer Moanna  5   7 , Jonathan Perkins  3 , Matthew Hogan  3 , Kanika M Sims  8 , Tolu Amzat  3 , Valeria D Cantos  5 , Temitope Elutilo-Ayoola  8 , Jasmah Hanna  3 , Nadine M Harris  5   9 , Tracey L Henry  10 , Onyinye Iheaku  3 , Mariam Japaridze  11 , Vaishnavi Lanka  12 , Theresa A Johnson  9 , Nkechi Mbaezue  8 , Paulina A Rebolledo  5 , Mary Elizabeth Sexton  5 , Phani Keerthi Surapaneni  8 , Nicole Franks  13
Affiliations

Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19

Zanthia Wiley et al. J Investig Med. 2022 Aug.

Abstract

COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.

Keywords: COVID-19; hospitals.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Comparing social determinants of health factors of readmitted to non-readmitted patients within race groups.
Figure 2
Figure 2
Impact of individual social determinants of health (via ZIP codes) on COVID-19 hospital readmissions. For lower confidence intervals, upper confidence intervals, and p-values, please see online supplemental table 3.
See this image and copyright information in PMC

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