Abstract
Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied. We therefore aimed to examine the association of public rental housing with readmission risk and increased utilization of hospital services in Singapore. We conducted a retrospective cohort study using retrospective 2014 data from Singapore General Hospital's electronic health records. Variables known to affect readmission risk and health-care utilization were identified a priori and include patient demographics, comorbidities, health-care utilization in the preceding 1 year and clinical variables from the index admission in 2014. Multivariate logistic regression was used to evaluate public rental housing as an independent risk factor for admission risk, emergency department (ED), and specialist outpatient clinic attendances. A total of 14,457 unique patients were analyzed, and 2,163 patients (15.0%) were rental housing residents. Rental housing patients were significantly more likely to be male; required financial assistance; have chronic obstructive pulmonary disease; usage of anti-depressant and anti-psychotic medications; longer length of hospital stay during the index admission; and higher Charlson Comorbidity Index scores. After adjusting for demographics and clinical variables, staying in public rental housing remained an independent risk factor for readmission within 15 and 30 days, frequent hospital admissions and ED attendances in Singapore. Our study showed an association between public rental housing with readmission risk and increased utilization of hospital services in Singapore. A deeper understanding of the residents' social circumstances and health seeking behavior would be insightful.
Highlights
Low socioeconomic status (SES) is well recognized as an independent risk factor for various adverse health outcomes, such as readmission risk [1,2,3] and hospital utilization [4]
Patients who stayed at rental housing were associated with younger age, male gender, non-Chinese ethnicity, requiring financial assistance, chronic obstructive pulmonary disease, usage of anti-depressant and psychotic medication, longer length of hospital stay during the index admission, higher LACE scores, higher proportion of patients with comorbidities, readmission within 15 and 30 days, frequent hospital admissions, and frequent emergency department (ED) visits
After adjusting for demographics and clinical conditions known to affect readmission risk and hospital services utilization, the relative risk (RR) of readmission within 15 and 30 days associated with residence in public rental housing was 1.19 (1.02–1.39), p = 0.029 and 1.27 (1.12–1.43), p < 0.001, respectively (Table 2)
Summary
Low socioeconomic status (SES) is well recognized as an independent risk factor for various adverse health outcomes, such as readmission risk [1,2,3] and hospital utilization [4]. Most studies evaluating the role of SES have concentrated on individual-level measures of SES, such as educational level, income inequality [7], employment status, or requirement for financial assistance [2]. Such detailed information on SES are rarely captured as part of routine clinical care. Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied.
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