Li Mingyue, Tang Haoqing, Zheng Huixian, Zhang Baisong, Cheng Haozhe, Wang Yanshang, Zhou Yuxun, Zhang Xiaotian, Geldsetzer Pascal, Liu Xiaoyun
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
Int J Equity Health. 2025 Mar 26;24(1):83. doi: 10.1186/s12939-025-02443-0.
Frequent hospital readmissions place a significant burden on patients, families, and society. Many high-income countries have implemented financial incentives to reduce readmissions. In China, readmission metrics have also been introduced as part of the performance evaluation for secondary hospitals. However, the understanding of hospital readmissions, particularly in rural and remote areas of China, remains limited. This study aims to analyze geographic disparities in hospital readmissions among high-need patients.
This retrospective cohort study used anonymized hospital discharge data from January 1, 2017, to December 31, 2021, from three public secondary county hospitals. We included rural patients aged 15 and older with hypertension or type 2 diabetes. The outcomes were 30-day, 90-day, and annual readmissions. The explanatory variable was the travel distance to county hospitals, calculated based on the longitude and latitude of registered addresses. Covariates included patient demographics (gender, age, marital status, and ethnicity); health status (Charlson comorbidity score, types of chronic diseases, surgery, and length of stay); and other factors (health insurance and admitted departments). We first reported unweighted readmissions stratified by travel distances (< 40 km versus ≥ 40 km). Multiple logistic regression models were then used to examine the relationship between travel distances and readmissions.
The 30-day, 90-day and annual readmission rates for hypertension or type 2 diabetes were 8.5%, 19.1%, and 39.7%, respectively. Patients living far away were more vulnerable - older (aged 65 and older 59.1% versus 58.5%, P < 0.001), predominantly minorities (Minority 55.6% versus 29.4%, P < 0.001), and having more hypertension and diabetes-related complications, as well as undergoing more surgeries (surgery 29.4% versus 23.3%, P < 0.001) compared to those living nearby. After adjusting covariates and weights, patients living 40 km away had 11% decrease in the odds of being readmitted within 30 days (OR = 0.89, 95%CI = 0.83-0.96), 10% decrease in the odds of 90-day readmissions (OR = 0.90, 95%CI = 0.85-0.94), and 13% decrease in the odds of annual readmissions (OR = 0.87, 95%CI = 0.84-0.91) compared to those living within 40 km.
We found significant geographic disparities in hospital readmissions among high-need patients. Patients living farther from hospitals had significantly lower odds of readmissions. Readmission rates reflect patients' healthcare utilization patterns in rural and remote areas. Policymakers should address the geographic access barriers and be cautious when using readmission rates as a measure of hospital performance.
频繁的医院再入院给患者、家庭和社会带来了沉重负担。许多高收入国家已实施经济激励措施以减少再入院情况。在中国，再入院指标也已作为二级医院绩效评估的一部分被引入。然而，对医院再入院情况的了解，尤其是在中国农村和偏远地区，仍然有限。本研究旨在分析高需求患者医院再入院情况的地理差异。
这项回顾性队列研究使用了来自三家县级公立二级医院2017年1月1日至2021年12月31日的匿名医院出院数据。我们纳入了年龄在15岁及以上患有高血压或2型糖尿病的农村患者。结局指标为30天、90天和年度再入院情况。解释变量为到县级医院的出行距离，根据注册地址的经度和纬度计算得出。协变量包括患者人口统计学特征（性别、年龄、婚姻状况和种族）；健康状况（查尔森合并症评分、慢性病类型、手术和住院时间）；以及其他因素（医疗保险和入院科室）。我们首先报告按出行距离（<40公里与≥40公里）分层的未加权再入院情况。然后使用多元逻辑回归模型来检验出行距离与再入院之间的关系。
高血压或2型糖尿病的30天、90天和年度再入院率分别为8.5%、19.1%和39.7%。居住在远处的患者更易出现以下情况——年龄更大（65岁及以上患者比例为59.1%对58.5%，P<0.001），主要为少数民族（少数民族患者比例为55.6%对29.4%，P<0.001），并且与居住在附近的患者相比，有更多高血压和糖尿病相关并发症，以及接受更多手术（手术患者比例为29.4%对23.3%，P<0.001）。在调整协变量和权重后，居住在40公里以外的患者在30天内再入院的几率降低了11%（OR=0.89，95%CI=0.83-0.96），90天再入院的几率降低了10%（OR=0.90，95%CI=0.85-0.94），年度再入院的几率降低了13%（OR=0.87，95%CI=0.84-0.91），与居住在40公里以内的患者相比。
我们发现高需求患者医院再入院情况存在显著的地理差异。居住距离医院较远的患者再入院几率显著更低。再入院率反映了农村和偏远地区患者的医疗服务利用模式。政策制定者应解决地理上的就医障碍，并在将再入院率用作医院绩效衡量指标时谨慎行事。
