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Research

Age trends in 30 day hospital readmissions: US national retrospective analysis

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k497 (Published 27 February 2018) Cite this as: BMJ 2018;360:k497
  1. Jay G Berry, assistant professor1 2,
  2. James C Gay, professor3,
  3. Karen Joynt Maddox, assistant professor4,
  4. Eric A Coleman, professor5,
  5. Emily M Bucholz, pediatrics resident1 2,
  6. Margaret R O’Neill, research assistant1,
  7. Kevin Blaine, program manager1,
  8. Matthew Hall, senior statistician6
  1. 1Division of General Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA
  2. 2Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
  3. 3Monroe Carell Jr Children’s Hospital at Vanderbilt Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
  4. 4Washington University School of Medicine, St Louis, MO 63110, USA
  5. 5Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
  6. 6Children’s Hospital Association, Lenexa, KS 66219, USA
  1. Correspondence to: Jay.berry{at}childrens.harvard.edu
  • Accepted 15 January 2018

Abstract

Objective To assess trends in and risk factors for readmission to hospital across the age continuum.

Design Retrospective analysis.

Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database.

Main outcome measure 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group.

Results The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile).

Conclusions The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.

Footnotes

  • Contributors: All authors made substantial contributions to the conception or design of the work. MH acquired and analyzed the data. All authors were involved in interpreting data and in drafting the manuscript and revising it critically for important intellectual content. All authors gave final approval of the version to be published and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JGB is the guarantor.

  • Funding: JGB and MH were supported by the Agency for Healthcare Research and Quality (R21 HS023092-01). JGB, KB, and MRO were supported by the Lucile Packard Foundation for Children’s Health. The funders were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The researchers conducted the work independently of the funders.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work other than that described above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was not considered human subject research by the Institutional Review Board at Vanderbilt University Medical Center, and ethics committee approval was therefore not required.

  • Transparency: The lead author (JGB) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: No additional data available.

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