University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Health Services & Care Research Program, Madison, WI, USA.
University of Wisconsin School of Medicine and Public Health, Department of Medicine, Rheumatology Division, Madison, WI, USA; University of Wisconsin Hospital and Clinics, Madison, WI, USA.
Semin Arthritis Rheum. 2021 Apr;51(2):477-485. doi: 10.1016/j.semarthrit.2021.02.006. Epub 2021 Feb 19.
Thirty-day hospital readmissions in systemic lupus erythematosus (SLE) approach proportions in Medicare-reported conditions including heart failure (HF). We compared adjusted 30-day readmission and mortality among SLE, HF, and general Medicare to assess predictors informing readmission prevention.
This database study used a 20% sample of all US Medicare 2014 adult hospitalizations to compare risk of 30-day readmission and mortality among admissions with SLE, HF, and neither per discharge diagnoses (if both SLE and HF, classified as SLE). Inclusion required live discharge and ≥12 months of Medicare A/B before admission to assess baseline covariates including patient, geographic, and hospital factors. Analysis used observed and predicted probabilities, and multivariable GEE models clustered by patient to report adjusted risk ratios (ARRs) of 30-day readmission and mortality.
SLE admissions (n=10,868) were younger, predominantly female, more likely to be Black, disabled, and have Medicaid or end-stage renal disease (ESRD). Observed 30-day readmissions of 24% were identical for SLE and HF (p = 0.6), and higher than other Medicare (16%, p < 0.001). Both SLE and HF had elevated readmission risk (ARR 1.08, (95% CI (1.04, 1.13)); 1.11, (1.09, 1.13)). SLE readmissions were higher for Black (30%) versus White (21%) populations, and highest in ages 18-33 (39%) and ESRD (37%). Admissions of Black patients with SLE from least disadvantaged neighborhoods had highest 30-day mortality (9% versus 3% White).
Thirty-day SLE readmissions rivaled HF at 24%. Readmission prevention programs should engage young, ESRD patients with SLE and examine potential causal gaps in SLE care and transitions.
红斑狼疮（SLE）患者的 30 天住院再入院率与医疗保险报告的心力衰竭（HF）等疾病的比例相近。我们比较了 SLE、HF 和一般医疗保险患者的 30 天再入院率和死亡率，以评估可预测再入院预防的指标。
本数据库研究使用了美国医疗保险 2014 年所有成人住院患者的 20%的样本，比较了 SLE、HF 和无 SLE 与 HF 的患者的 30 天再入院率和死亡率的风险。纳入标准为出院时存活且在入院前至少有 12 个月的医疗保险 A/B 资格，以评估患者、地理和医院因素等基线协变量。分析采用观察概率和预测概率以及按患者聚类的多变量 GEE 模型，报告 30 天再入院和死亡率的调整风险比（ARR）。
SLE 患者（n=10868）更年轻，主要为女性，更有可能为黑人，残疾，拥有医疗补助或终末期肾病（ESRD）。观察到的 24%的 30 天再入院率在 SLE 和 HF 之间相同（p=0.6），高于其他医疗保险患者（16%，p<0.001）。SLE 和 HF 都有较高的再入院风险（ARR 1.08，（95%CI（1.04，1.13））；1.11，（1.09，1.13））。SLE 的黑人（30%）再入院率高于白人（21%），18-33 岁（39%）和 ESRD（37%）的再入院率最高。来自最不利社区的 SLE 黑人患者的入院后 30 天死亡率最高（9%比白人 3%）。
SLE 患者的 30 天再入院率与 HF 相当，达到 24%。再入院预防计划应针对年轻的 ESRD SLE 患者，并检查 SLE 护理和过渡方面可能存在的因果差距。
