ASPO Abstracts
RACIAL AND ETHNIC DIFFERENCES IN 60- DAY HOSPITAL READMISSIONS FOR PATIENTS WITH BREAST, COLORECTAL, LUNG, AND PROSTATE CANCER
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose: This study examines the patient, hospital, and state-level factors contributing to 60-day hospital readmissions among diverse patient groups hospitalized with a primary diagnosis of breast, colorectal, lung, or prostate cancer.Methods: We analyzed data from the 2016 Nationwide Inpatient Sample (NIS) database. This study included 43,781 adult Black, White, Hispanic, and Asian/Pacific Islander patients discharged alive from the hospital following an index admission with a principal diagnosis of cancer. Multivariable adjusted logistic regression and Generalized Estimating Equation models were used to estimate the observed-to-expected ratio for patient (insurance, income), hospital (hospital type), and state (Medicaid expansion) level factors associated with 60-day hospital readmission following discharge adjusting for demographics and comorbidities.Results: Compared with White patients, Black patients had higher odds of 60-day hospital readmission for all four types of cancer combined (OR, 1.13; 95% CI, 1.03-1.25), separately for prostate (OR, 1.19; 95% CI, 1.01-1.41) and lung (OR, 1.34; 95% CI, 1.18-1.52). For all cancers combined, higher observed-to-expected (OE) 60-day readmission rate ratio was associated with low vs. high income (OE ratio, 1.06; 95% CI, 1.01-1.12) and Medicaid vs. private insurance (OE ratio: 1.27; 95% CI, 1.18-1.37) for Black patients. Black patients with prostate cancer had a high OE ratio if they were in the highest income (OE ratio 1.37; 95% CI, 1.18-1.58), admitted in urban hospitals with >300 beds; (OE ratio 1.34; 95% CI, 1.16-1.55), non-Medicaid expansion state (OE ratio 1.26; 95% CI, 1.15 -1.36) and self-pay (OE ratio 2.75; 95% CI, 2.25-3.37). In Lung cancer, Black patients had a high OE ratio if they were low vs. high income (OE ratio: 1.31; 95% CI, 1.19-1.43), admitted to rural vs. urban hospitals (OE ratio 2.30; 95% CI, 1.89-2.79), non-Medicaid expansion state (OE ratio 1.18; 95% CI, 1.07 -1.31) and on Medicaid vs. private insurance (OE 1.38; 95% CI, 1.19-1.60).Conclusion: Black-White disparities in 60-day hospital readmission rates are driven by multi-level social determinants of health factors. Identifying these associations will help develop strategies to overcome the barriers limiting access to quality care.
Keywords: Health Disparity, Readmission, Cancer