Ehrman Robert R, Haber Brian D, Harrison Nicholas E, Korzeniewski Steven J, Maguire Lindsay, Bauer Samantha D, Levy Phillip D
Department of Emergency Medicine, Wayne State University School of Medicine, Integrative Biosciences Center, Detroit, Michigan, United States of America.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
PLoS One. 2025 Jul 3;20(7):e0327123. doi: 10.1371/journal.pone.0327123. eCollection 2025.
Hospital readmissions are a pervasive problem for patients with heart failure. While Social Determinants of Health (SDoH) influence many aspects of care, the relationship between readmissions for acute heart failure (AHF) and social vulnerability is incompletely characterized. Such data are needed to develop interventions to maximize successful stabilization in the post-discharge phase.
Retrospective review of administrative clinical data paired with ZIP code-level SDoH data from an integrated health system in Detroit, MI. We explored the relationship between Social Deprivation Index (SDI; greater scores indicate more deprivation) and hospital admissions for AHF within 180-days of a prior AHF admission using zero-hurdle regression (logistic model for >0 readmissions; negative binomial model for count of readmissions). Mixed-effects logistic regression, accounting for repeat visits, was used to determine if SDI was associated with AHF-admission for any given ED visit.
From January 2022 through December 2023, with data from 2,333 unique patients (accounting for 3,281 total visits), we found that each SD increase in SDI (30.6) was associated with increased likelihood of at least one 180day-readmission (OR 1.52 [CI 1.10-2.11]). In the count model, each SD (28.3) increase in SDI was positively associated with 180day-readmissions (relative risk (RR) 1.57 [CI 1.10-1.23]). In the mixed model, after adjusting for characteristics of prior visits, SDI was not associated with AHF admission (including at Index visits).
These results indicate that area-level social vulnerability may play a role in recovery and stabilization after a decompensation event; it may also extend the post-discharge vulnerable phase. That SDI was not associated with Index AHF admission suggests that social factors may play a different role in development of acute decompensation, as opposed to recovery from it. Development of targeted admission-reduction interventions should consider the varied influences of social vulnerability in the AHF lifecycle.
医院再入院是心力衰竭患者普遍存在的问题。虽然健康的社会决定因素（SDoH）会影响护理的许多方面，但急性心力衰竭（AHF）再入院与社会脆弱性之间的关系尚未完全明确。需要此类数据来制定干预措施，以在出院后阶段最大程度地实现成功稳定病情。
对密歇根州底特律市一个综合医疗系统的行政临床数据与邮政编码级别的SDoH数据进行回顾性分析。我们使用零障碍回归（用于>0次再入院的逻辑模型；用于再入院次数计数的负二项式模型），探讨了社会剥夺指数（SDI；分数越高表明剥夺程度越高）与前一次AHF入院后180天内AHF再次入院之间的关系。采用考虑重复就诊情况的混合效应逻辑回归，以确定SDI是否与任何给定急诊就诊时的AHF入院相关。
从2022年1月至2023年12月，基于2333名独特患者的数据（共计3281次就诊），我们发现SDI每增加一个标准差（30.6），至少发生一次180天再入院的可能性就会增加（比值比[OR]为1.52[置信区间1.10 - 2.11]）。在计数模型中，SDI每增加一个标准差（28.3）与180天再入院呈正相关（相对风险[RR]为1.57[置信区间1.10 - 1.23]）。在混合模型中，在调整了先前就诊的特征后，SDI与AHF入院无关（包括首次就诊时）。
这些结果表明，地区层面的社会脆弱性可能在失代偿事件后的恢复和稳定中发挥作用；它也可能延长出院后的脆弱期。SDI与首次AHF入院无关，这表明社会因素在急性失代偿的发生中可能发挥不同的作用，与从急性失代偿中恢复的情况不同。制定有针对性的减少再入院干预措施时，应考虑社会脆弱性在AHF生命周期中的不同影响。
