Methods: We examined the 2013 Nationwide Readmission Database (NRD), a nationally representative all-payer database of inpatient hospitalizations, for readmissions following a principal discharge diagnosis of pneumonia. We identified adults (≥18 years) discharged alive after a hospitalization with the primary diagnosis as pneumonia [ICD-9 codes 48x.x] between January 1, 2013 – November 30, 2013. We used covariates included in the Center for Medicare & Medicaid Services (CMS) risk – adjustment model for pneumonia readmissions in a multivariable hierarchical regression model for survey data to identify predictors of 30-day readmission. We also examined how readmission rates varied across key demographic subgroups based on age and gender.
Results: We identified 766,490 index pneumonia hospitalizations (mean age 48.7 years, 47% men), with 269,717 cases in the < 65 years of age population (35%) and 496,774 in ≥65 age group (65%). Overall, 16% patients were readmitted within 30 days of their hospitalization for pneumonia, with 15.2% (n=41,114) in < 65year age-group and 16.7% (n=82,981) in ≥65 year age-group. Overall cost of index hospitalizations was $8.5 billion and of readmissions was $1.8 billion. Mean cost per readmission was $15,879 in the < 65 year age-group and $14,443 in the ≥65 year age-group. The current CMS risk-adjustment model performed modestly in our all-payer population, which included patients below 65 years of age (model c-statistic 0.63). The independent predictors of pneumonia readmission in the above model are presented in the figure. Among all co-morbidities, end stage renal disease or dependence on dialysis had the highest odds of predicting readmissions (risk adjusted OR: 1.87, 95% C.I.1.79 – 1.96). In risk-adjusted analyses, the elderly had a slightly higher predisposition for readmissions (risk-adjusted OR: 1.06, 95% C.I. 1.02 – 1.10). Further, compared to women, men had higher odds of readmission in both younger (risk adjusted OR: 0.92 95% C.I. 0.89 to 0.96) and older age groups (risk-adjusted OR: 0.97, 95% C.I. 0.94 – 0.99, P for age*gender interaction 0.09). These age and gender differences persisted despite additional adjustment for socioeconomic status.
Conclusions: Young and middle-aged adults experience substantial rates of 30-day readmission that are comparable to those over the age of 65 years. This poses a considerable economic burden on our healthcare system. Further, in contrast to common cardiovascular conditions, like myocardial infarction and heart failure where women have higher readmission risk, risk-adjusted odds of readmission for pneumonia were higher in men across age groups, with slightly higher rates in the younger age group. Future efforts are needed to identify potential interventions to alleviate the high burden of pneumonia readmissions in young and middle-aged adults.
To cite this abstract:Jain, S; Khera, R; Weissler, J . BURDEN OF 30-DAY READMISSIONS FOLLOWING HOSPITALIZATION FOR PNEUMONIA IN YOUNG AND MIDDLE-AGED ADULTS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 82. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/burden-of-30-day-readmissions-following-hospitalization-for-pneumonia-in-young-and-middle-aged-adults/. Accessed May 24, 2019.