Lower household income is associated with an increased risk of hospital readmission in patients with decompensated cirrhosis.

Abstract

The impact of household income, a surrogate of socioeconomic status, on hospital readmission rates for patients with decompensated cirrhosis has not been well characterized. The Nationwide Readmission Database from 2012 to 2014 was used to study the association of lower median household income on 30-, 90-, and 180-day hospital readmission rates for patients with decompensated cirrhosis. From the 42679001 hospital admissions contained in the sample, there were 82598 patients with decompensated cirrhosis who survived a hospital admission in the first 6months of the year. During a uniform 6-month follow-up period, 25914 (31.4%), 39928 (48.3%), and 47496 (57.5%) patients were readmitted at 30, 90, and 180days, respectively. After controlling for demographic and clinical confounders, patients residing in the three lowest income quartiles were significantly more likely to be readmitted at 30days than those in the fourth quartile (first quartile, odds ratio [OR] 1.32 [95% confidence interval, CI, 1.17-1.47, P<0.01]; second quartile, OR 1.25 [95% CI 1.13-1.38, P<0.01]; and third quartile, OR 1.08 [95% CI 0.97-1.20, P=0.07]). The association between lower socioeconomic status and the higher risk of readmissions persisted at 90days (first quartile, OR 1.21 [95% CI 1.14-1.30, P<0.01]) and 180days (first quartile, OR 1.32 [95% CI 1.20-1.44, P<0.01]). Patients with decompensated cirrhosis residing in the lowest income quartile had a 32% higher odds of hospital readmissions at 30, 90, and 180days compared with those in the highest income quartile.