The Impact of Baseline Economic Disparity on All-Cause 90-Day Readmissions Within a National Cohort of Sepsis Survivors
Abstract
BACKGROUND: Sepsis is a leading cause of hospital readmission. Preexisting economic hardships may lead to increased hospital readmissions. OBJECTIVES: To examine the causal impact of economic disparity on unplanned 90-day readmissions after sepsis and to identify factors associated with readmission. METHODS: We identified a prospective, records-based cohort of US adult sepsis survivors within the 2018 Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision, Clinical Modification codes for sepsis between January and September. Sepsis survivors were followed for unplanned all-cause 90-day readmissions. We examined the impact of preadmission factors (demographic factors, access to care, and income), index hospitalization factors (severity of illness, length of stay, and discharge destination) on all-cause 90-day readmissions using a directed acetyl graph to guide the analysis using baseline income as the independent variable. We used descriptive statistics and regression models to examine the associations with hospital readmissions and 1:1 propensity matching to control for potential confounding and for sensitivity analysis. RESULTS: We identified a large national cohort of sepsis survivors (N = 2 850 357). The 90-day all-cause readmission rate was 17.3% for the cohort and 30.8% for survivors in the lowest-income quartile. As income increased, the risk of readmission decreased (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.86-0.89]). All directed acetyl graph preadmission factors and index hospitalization factors were associated with an increased risk of readmission except younger age, mechanical ventilation during index hospital stay, and self-pay status. After adjustment, having 2 or more comorbidities (OR, 2.39; 95% CI, 2.36-2.41) had the strongest risk for all-cause readmissions, followed by discharge against medical advice (OR, 2.09; 95% CI, 2.02-2.16). Sepsis and infections were common causes of readmission after sepsis. DISCUSSION: Higher level of income at the time of the index hospital stay protects against hospital readmission in sepsis survivors. More research is needed to understand the impact of economic disparities on the trajectory of recovery after sepsis, including hospital readmission and the impact of modifiable and nonmodifiable risk factors.
Publication Title
Dimensions of Critical Care Nursing DCCN
Recommended Citation
Umberger, R., Womeodu, R., Abrar, M., Mary, A., Hutchison, A., & Jiang, Y. (2025). The Impact of Baseline Economic Disparity on All-Cause 90-Day Readmissions Within a National Cohort of Sepsis Survivors. Dimensions of Critical Care Nursing DCCN, 44 (6), 320-327. https://doi.org/10.1097/DCC.0000000000000724
