Zhou Guangjin, Mintz Laura J, Schiltz Nicholas K, Spilsbury James C, Bensken Wyatt P, Osazuwa-Peters Nosayaba, Koroukian Siran M
Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, WG-43, Cleveland, OH, 44106-4945, USA.
Department of Internal Medicine-Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA.
Sci Rep. 2025 Apr 5;15(1):11694. doi: 10.1038/s41598-025-96069-5.
Health-related social needs (HRSN) significantly influence healthcare utilization and outcomes. While prior studies have shown higher rates of hospital readmissions among individuals with HRSN, the impact of HRSN on hospital readmissions in persons living with HIV (PLWH) at population level, using ICD10 codes for HRSN in hospital discharge data, has not been fully explored. In this retrospective study using the 2016-2019 Florida and Maryland State Inpatient Database (SID), we examined the prevalence of HRSN among hospitalized PLWH using ICD-10 diagnosis codes including the domains of employment, family, housing, psychosocial, and education. In addition to descriptive analysis, we used multivariable logistic regression models to evaluate the association between hospital readmission and the presence of HRSN, controlling for potential confounders. In Florida, we identified 43,229 PLWH patients, of whom 9.6% (4,153) had HRSN. PLWH with HRSN had a significantly higher 90-day (40.6% vs. 23.1%) and one-year (73.6% vs. 41.3%) readmission rates compared with those without HRSN. Multivariable regression analysis showed that patients with HRSN had nearly three times the odds of 90-day readmission [adjusted odds ratio (aOR): 2.80 (95% confidence interval (CI): 2.61-3.01)] and four times the odds of one-year readmission [aOR: 3.93(95% CI: 3.62-4.27)]. In the Maryland SID, 12.5% (1,551) of the 12,396 PLWH had HRSN. PLWH with documented HRSN had a significantly higher 90-day (39.9% vs. 20.4%) and one-year (68.2% vs. 37.9%) readmission rates than those without HRSN. In multivariable regression analysis, HRSN were similarly associated with substantially higher odds of 90-day readmission [aOR: 2.70(95% CI: 2.38-3.05)] and one-year readmission [aOR: 3.60(95% CI: 3.15-4.12)]. In both states, there was a dose-response relationship between the number of HRSN and readmission rates. In conclusion, the prevalence of HRSN is associated with significantly higher rates of hospital readmissions among PLWH. Our findings highlight the importance of accounting for social factors when studying hospital readmissions and call for the development of interventions targeting HRSN to reduce readmissions in PLWH.
与健康相关的社会需求（HRSN）对医疗保健的利用和结果有重大影响。虽然先前的研究表明，有HRSN的个体再次住院的比例较高，但在人群层面，利用医院出院数据中的HRSN的ICD10编码，HRSN对艾滋病毒感染者（PLWH）再次住院的影响尚未得到充分探讨。在这项使用2016 - 2019年佛罗里达州和马里兰州住院患者数据库（SID）的回顾性研究中，我们使用包括就业、家庭、住房、心理社会和教育等领域的ICD - 10诊断编码，检查了住院PLWH中HRSN的患病率。除了描述性分析外，我们还使用多变量逻辑回归模型来评估再次住院与HRSN的存在之间的关联，并控制潜在的混杂因素。在佛罗里达州，我们确定了43229名PLWH患者，其中9.6%（4153名）有HRSN。与没有HRSN的患者相比，有HRSN的PLWH的90天（40.6%对23.1%）和一年（73.6%对41.3%）再次住院率显著更高。多变量回归分析表明，有HRSN的患者90天再次住院的几率几乎是其三倍[调整后的优势比（aOR）：2.80（95%置信区间（CI）：2.61 - 3.01）]，一年再次住院的几率是其四 倍[aOR：3.93（95%CI：3.62 - 4.27）]。在马里兰州SID中，12396名PLWH中有12.5%（1551名）有HRSN。有记录的HRSN的PLWH的90天（39.9%对20.4%）和一年（68.2%对37.9%）再次住院率显著高于没有HRSN的患者。在多变量回归分析中，HRSN同样与90天再次住院率大幅升高的几率相关[aOR：2.70（95%CI：2.38 - 3.05）]和一年再次住院率相关[aOR：3.60（95%CI：3.15 - 4.12）]。在两个州，HRSN的数量与再次住院率之间都存在剂量反应关系。总之，HRSN的患病率与PLWH中显著更高的再次住院率相关。我们的研究结果强调了在研究再次住院时考虑社会因素的重要性，并呼吁制定针对HRSN的干预措施以降低PLWH的再次住院率。
