JACC. Advances · 2025
Social Determinants of Health and 30-Day Readmission After Acute Myocardial Infarction in the REGARDS Study.
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Amankwah Koby K, Soroka Orysya, Pinheiro Laura, Sterling Madeline R, Amankwah Ernest K, Almarzooq Zaid, Paul Tracy, Goyal Parag, Safford Monika M
Аннотация
BACKGROUND: Social determinants of health (SDOH) may influence 30-day readmission or emergency department (ED) use following acute myocardial infarction (AMI) hospitalizations. Understanding this relationship will promote the development of interventions and policies to reduce readmissions.
OBJECTIVES: The aim of the study was to test associations between SDOH and readmission after AMI.
METHODS: In this cross-sectional study, we analyzed 753 adults ≥65 years from the Reasons for Geographic and Racial Differences in Stroke study discharged after an AMI between 2003 and 2019. Participants were categorized into 3 groups (0/1, 2, and 3+) based on the number of SDOHs. Poisson models were used to determine relative risks (RRs) and corresponding 95% CI for the associations between SDOH and risk of readmission/ED visit.
RESULTS: Of participants, 39.1% (295/753) were women, 27.5% (207/753) were Black, and the median age was 77 years (72-82 years). There were 219 (29.1%) individuals with readmission/ED visit. Of 612 participants with validated SDOH counts, 273 (44.6%) had 0/1 SDOH, 117 (19.1%) had 2 SDOH, and 222 (36.3%) had 3+ SDOH. After adjusting for age and region, increasing number of SDOHs was associated with elevated readmission/ED visit risk (2 SDOH: RR: 1.15; 95% CI: 0.83-1.60; 3+ SDOH: RR: 1.56; 95% CI: 1.20-2.01; P trend = 0.001). Similar results were observed in the fully adjusted model (2 SDOH: RR: 1.12; 95% CI: 0.81-1.56; 3+ SDOH: RR: 1.37; 95% CI: 1.04-1.80; P trend = 0.026).
CONCLUSIONS: A cumulative burden of SDOHs is associated with an increased risk of readmission/ED visits after AMI hospitalization. SDOH burden may be a useful approach in identifying individuals presenting with AMI who are most vulnerable for readmission.
OBJECTIVES: The aim of the study was to test associations between SDOH and readmission after AMI.
METHODS: In this cross-sectional study, we analyzed 753 adults ≥65 years from the Reasons for Geographic and Racial Differences in Stroke study discharged after an AMI between 2003 and 2019. Participants were categorized into 3 groups (0/1, 2, and 3+) based on the number of SDOHs. Poisson models were used to determine relative risks (RRs) and corresponding 95% CI for the associations between SDOH and risk of readmission/ED visit.
RESULTS: Of participants, 39.1% (295/753) were women, 27.5% (207/753) were Black, and the median age was 77 years (72-82 years). There were 219 (29.1%) individuals with readmission/ED visit. Of 612 participants with validated SDOH counts, 273 (44.6%) had 0/1 SDOH, 117 (19.1%) had 2 SDOH, and 222 (36.3%) had 3+ SDOH. After adjusting for age and region, increasing number of SDOHs was associated with elevated readmission/ED visit risk (2 SDOH: RR: 1.15; 95% CI: 0.83-1.60; 3+ SDOH: RR: 1.56; 95% CI: 1.20-2.01; P trend = 0.001). Similar results were observed in the fully adjusted model (2 SDOH: RR: 1.12; 95% CI: 0.81-1.56; 3+ SDOH: RR: 1.37; 95% CI: 1.04-1.80; P trend = 0.026).
CONCLUSIONS: A cumulative burden of SDOHs is associated with an increased risk of readmission/ED visits after AMI hospitalization. SDOH burden may be a useful approach in identifying individuals presenting with AMI who are most vulnerable for readmission.