基于年龄分层的 30 天再住院率和死亡率以及红斑狼疮患者再住院的预测因素：一项 Medicare 队列研究。
Age-Stratified 30-day Rehospitalization and Mortality and Predictors of Rehospitalization Among Patients With Systemic Lupus Erythematosus: A Medicare Cohort Study.
机构信息
M. Schletzbaum, PhD, B.C. Astor, PhD, MPH, Department of Population Health Sciences, and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
出版信息
J Rheumatol. 2023 Mar;50(3):359-367. doi: 10.3899/jrheum.220025. Epub 2022 Aug 15.
OBJECTIVE
Recent studies suggest young adults with systemic lupus erythematosus (SLE) have high 30-day readmission rates, which may necessitate tailored readmission reduction strategies. To aid in risk stratification for future strategies, we measured 30-day rehospitalization and mortality rates among Medicare beneficiaries with SLE and determined rehospitalization predictors by age.
METHODS
In a 2014 20% national Medicare sample of hospitalizations, rehospitalization risk and mortality within 30 days of discharge were calculated for young (aged 18-35 yrs), middle-aged (aged 36-64 yrs), and older (aged 65+ yrs) beneficiaries with and without SLE. Multivariable generalized estimating equation models were used to predict rehospitalization rates among patients with SLE by age group using patient, hospital, and geographic factors.
RESULTS
Among 1.39 million Medicare hospitalizations, 10,868 involved beneficiaries with SLE. Hospitalized young adult beneficiaries with SLE were more racially diverse, were living in more disadvantaged areas, and had more comorbidities than older beneficiaries with SLE and those without SLE. Thirty-day rehospitalization was 36% among young adult beneficiaries with SLE-40% higher than peers without SLE and 85% higher than older beneficiaries with SLE. Longer length of stay and higher comorbidity risk score increased odds of rehospitalization in all age groups, whereas specific comorbid condition predictors and their effect varied. Our models, which incorporated neighborhood-level socioeconomic disadvantage, had moderate-to-good predictive value (C statistics 0.67-0.77), outperforming administrative data models lacking comprehensive social determinants in other conditions.
CONCLUSION
Young adults with SLE on Medicare had very high 30-day rehospitalization at 36%. Considering socioeconomic disadvantage and comorbidities provided good prediction of rehospitalization risk, particularly in young adults. Young beneficiaries with SLE with comorbidities should be a focus of programs aimed at reducing rehospitalizations.
目的
最近的研究表明，患有系统性红斑狼疮（SLE）的年轻成年人有较高的 30 天再入院率，这可能需要制定有针对性的降低再入院率的策略。为了帮助为未来的策略进行风险分层，我们测量了 Medicare 受益人群中患有 SLE 的患者的 30 天再住院率和死亡率，并按年龄确定了再入院的预测因素。
方法
在 2014 年 Medicare 20%的全国住院患者样本中，计算了有和没有 SLE 的年轻（18-35 岁）、中年（36-64 岁）和老年（65 岁及以上）受益人群出院后 30 天内的再住院风险和死亡率。使用广义估计方程模型，根据患者、医院和地理因素，预测 SLE 患者按年龄组的再住院率。
结果
在 139 万 Medicare 住院患者中，有 10868 名患者患有 SLE。患有 SLE 的年轻成年患者在种族上更加多样化，居住在条件较差的地区，合并症比老年 SLE 患者和无 SLE 患者更多。年轻 SLE 患者的 30 天再住院率为 36%，比无 SLE 患者高 40%，比老年 SLE 患者高 85%。较长的住院时间和较高的合并症风险评分增加了所有年龄组再住院的几率，而特定的合并症预测因素及其影响在不同年龄组有所不同。我们的模型纳入了社区层面的社会经济劣势因素，具有中等至良好的预测价值（C 统计量为 0.67-0.77），优于在其他疾病中缺乏全面社会决定因素的行政数据模型。
结论
在 Medicare 中，患有 SLE 的年轻成年人的 30 天再住院率非常高，达到 36%。考虑到社会经济劣势和合并症，可以很好地预测再住院风险，特别是在年轻成年人中。患有 SLE 的年轻合并症患者应成为旨在降低再住院率的项目的重点关注对象。
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