INSURANCE DISPARITY OF 30-DAY READMISSION IN NONELDERLY PATIENTS WITH ANGIOEDEMA: A NATIONWIDE ANALYSIS

Abstract

SESSION TITLE: Allergy and Airway SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Angioedema is one of the critical diseases that may require hospitalization and even intubation. We studied risk factors of 30-day readmission in patients under age 65 admitted with angioedema and identified insurance disparity as an important risk factor. METHODS: We did a retrospective cohort study using the 2014 National Readmission Database. We included discharges that were non-elective with a primary diagnosis ICD-9 code indicating Angioedema and age less than 65. A readmission is defined as the first admission to hospital for any non-trauma cause within 30 days of the index admission. The primary outcome is the 30-day readmission rate. Secondary outcomes include mortality rate, most common primary causes for readmission, readmission risk factors were identified using multivariate regression analysis. RESULTS: The total number of admissions for angioedema in non-elderly population was 10,075. The mean age was 49.0, 53.1% of the total admissions were female. The all-cause 30-day mortality rate in Angioedema patients was 0.4% with an in-hospital mortality rate of 0.3%. 15.6% of admitted angioedema patients were intubated and 12.5% were intubated within 24 hours. The all cause and the angioedema-specific 30-day readmission rate was 5.4% and 0.2%, respectively. The in-hospital mortality rate for the readmitted patients was 2.0%. The most common cause for readmission include (top 1-3): Unspecified septicemia, Angioneurotic edema, Fluid overload. Various possible risk factors were identified using univariate regression analysis. The odds ratios (ORs) and p-values were calculated using multivariable logistic regression and independent predictors for readmission were identified: Medicaid (OR 1.72; 95% CI 1.18-2.50) and Medicare (OR 2.19; 95% CI 1.48-3.22) after adjusting for sex, age group, hospital volume quintile, teaching status, COPD, early intubation (within 24 hours and 72 hours of admission), adverse drug effect and clinical comorbidity (asthma was not adjusted given all readmitted patients had asthma); higher Charlson comorbidity score was also a risk factor of higher readmission rates. CONCLUSIONS: Angioedema has a low mortality rate both in-hospital and within 30 days in non-elderly population. The readmission rate is low but patients with Medicaid or Medicare are more likely to get readmitted within 30 days after discharge. Readmissions are mostly for non-angioedema causes. Early intubation is not uncommon for hospitalized angioedema patients but it is not identified a risk factor for readmission. CLINICAL IMPLICATIONS: Higher readmission rates among non-elderly angioedema patients with Medicaid or Medicare may reflect their poor health literacy and limited access to primary care and allergy/immunology specialist given their insurance status. These patients may need special attention and more detailed instructions before discharge to decrease further readmission and related healthcare burden. DISCLOSURES: No relevant relationships by Xiaowen Fan, source=Web Response No relevant relationships by Changchuan Jiang, source=Web Response No relevant relationships by Yiming Luo, source=Web Response No relevant relationships by BING YUE, source=Web Response