Factors associated with racial differences in all-cause 30-day readmission in adults with cardiovascular disease: an observational study of a large healthcare system.
Factors associated with racial differences in all-cause 30-day readmission in adults with cardiovascular disease: an observational study of a large healthcare system.
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DOI：
10.1136/bmjopen-2021-051661
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发表时间：
2022-11-24
期刊：
影响因子：
2.9
通讯作者：
Dupre, Matthew E.
中科院分区：
文献类型：
--
作者：
Farmer, Heather R.;Xu, Hanzhang;Granger, Bradi B.;Thomas, Kevin L.;Dupre, Matthew E.
研究导致心血管疾病（CVD）患者30天再入院的种族差异的因素。患者入组时间为2015年1月1日至2017年8月31日，数据收集自电子健康记录和出院前进行的标准化访谈。杜克大学健康系统的杜克心脏中心。18岁及以上患者因心血管相关疾病入院治疗（n = 734）。30天内全因再入院是主要结局。多变量逻辑回归模型被用来检查是否以及在何种程度上社会经济，心理，行为和医疗保健相关因素有助于30天的再入院，在黑人和白色CVD患者。患者的中位年龄为66岁，18.1%（n = 133）在出院后30天内再次入院。黑人患者比白色患者更有可能再次入院（OR 1.62; 95% CI 1.18 - 2.23），考虑到广泛的临床和非临床因素差异后，再次入院的种族差异大大降低（OR 1.37; 95% CI 0.98 - 1.91）。在黑人患者中，退休患者的再入院风险尤其高（OR 3.71; 95% CI 1.71 - 8.07），从未结婚（OR 2.21; 95% CI 1.21 - 4.05），难以获得常规护理（OR 2.88; 95% CI 1.70 - 4.88）或在前一年住院（OR 1.97; 95% CI 1.16 - 3.37）。在白色患者中，丧偶（OR 2.39; 95% CI 1.41 - 4.07）和报告较多抑郁症状（OR 1.07; 95% CI 1.00 - 1.13）是与较高再入院风险相关的关键因素。黑人患者比白色患者更有可能在因CVD住院后30天内再次入院。导致再入院的因素因种族而异，并为识别再入院高风险患者和定制干预措施以降低这些风险提供了重要线索。
To examine factors contributing to racial differences in 30-day readmission in patients with cardiovascular disease (CVD). Patients were enrolled from 1 January 2015 to 31 August 2017 and data were collected from electronic health records and a standardised interview administered prior to discharge. Duke Heart Center in the Duke University Health System. Patients aged 18 and older admitted for the treatment of cardiovascular-related conditions (n=734). All-cause readmission within 30 days was the main outcome. Multivariate logistic regression models were used to examine whether and to what extent socioeconomic, psychosocial, behavioural and healthcare-related factors contributed to 30-day readmissions in Black and White CVD patients. The median age of patients was 66 years and 18.1% (n=133) were readmitted within 30 days after discharge. Black patients were more likely than White patients to be readmitted (OR 1.62; 95% CI 1.18 to 2.23) and the racial difference in readmissions was largely reduced after taking into account differences in a wide range of clinical and non-clinical factors (OR 1.37; 95% CI 0.98 to 1.91). In Black patients, readmission risks were especially high in those who were retired (OR 3.71; 95% CI 1.71 to 8.07), never married (OR 2.21; 95% CI 1.21 to 4.05), had difficulty accessing their routine care (OR 2.88; 95% CI 1.70 to 4.88) or had been hospitalised in the prior year (OR 1.97; 95% CI 1.16 to 3.37). In White patients, being widowed (OR 2.39; 95% CI 1.41 to 4.07) and reporting a higher number of depressive symptoms (OR 1.07; 95% CI 1.00 to 1.13) were the key factors associated with higher risks of readmission. Black patients were more likely than White patients to be readmitted within 30 days after hospitalisation for CVD. The factors contributing to readmission differed by race and offer important clues for identifying patients at high risk of readmission and tailoring interventions to reduce these risks.
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