Skip to main content

Advertisement

SpringerLink
Log in

Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Risk adjustment for reimbursement and quality measures omits social risk factors despite adversely affecting health outcomes. Social risk factors are not usually available in electronic health records (EHR) or administrative data. Socioeconomic status can be assessed by using US Census data. Distressed Communities Index (DCI) is based upon zip codes, and the Area Deprivation Index (ADI) provides more granular estimates at the block group level. We examined the association of neighborhood disadvantage using the ADI, DCI, and patient-level insurance status on 30-day readmission risk after colorectal surgery.

Methods

Our 677 patient cohort was derived from the 2013–2017 National Surgical Quality Improvement Program at a safety net hospital augmented with EHR data to determine insurance status and 30-day readmissions. Patients’ home addresses were linked to the ADI and DCI.

Results

Our cohort consisted of 53.9% males and 63.8% Hispanics with a 22.9% 30-day readmission rate from the date of discharge; > 50% lived in highly deprived neighborhoods. Controlling for medical comorbidities and complications, ADI was associated with increased risk of 30 days from the date of discharge readmissions among patients living in medium (OR = 2.15, p = .02) or high (OR = 1.88, p = .03) deprived areas compared to less-deprived neighborhoods, but not insurance status or DCI.

Conclusions

The ADI identified patients living in deprived communities with increased readmission risk. Our results show that block-group level ADI can potentially be used in risk adjustment, to identify high-risk patients and to design better care pathways that improve health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, Sadiraj V, and Sweeney JF, Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg, 2012. 215(3): p. 322-330.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sastow DL, White RS, Mauer E, Chen Y, Gaber-Baylis LK, and Turnbull ZA, The Disparity of Care and Outcomes for Medicaid Patients Undergoing Colectomy. J Surg Res, 2019. 235: p. 190-201.

    Article  PubMed  Google Scholar 

  3. Favini N, Hockenberry JM, Gilman M, Jain S, Ong MK, Adams EK, and Becker ER, Comparative Trends in Payment Adjustments Between Safety-Net and Other Hospitals Since the Introduction of the Hospital Readmission Reduction Program and Value-Based Purchasing. JAMA, 2017. 317(15): p. 1578-1580.

    Article  PubMed  Google Scholar 

  4. Shih T, Ryan AM, Gonzalez AA, and Dimick JB, Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals. Ann Surg, 2015. 261(6): p. 1027-1031.

    Article  PubMed  Google Scholar 

  5. Salerno AM, Horwitz LI, Kwon JY, Herrin J, Grady JN, Lin Z, Ross JS, and Bernheim SM, Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015. BMJ Open, 2017. 7(7): p. e016149.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Thompson MP, Waters TM, Kaplan CM, Cao Y, and Bazzoli GJ, Most Hospitals Received Annual Penalties For Excess Readmissions, But Some Fared Better Than Others. Health Aff (Millwood), 2017. 36(5): p. 893-901.

    Article  Google Scholar 

  7. Glance LG, Kellermann AL, Osler TM, Li Y, Li W, and Dick AW, Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates. Ann Surg, 2016. 263(4): p. 698-704.

    Article  PubMed  Google Scholar 

  8. Park HS, White RS, Ma X, Lui B, and Pryor KO, Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009-2014. J Comp Eff Res, 2019. 8(16): p. 1365-1379.

    Article  PubMed  Google Scholar 

  9. McCarthy CP, Vaduganathan M, Patel KV, Lalani HS, Ayers C, Bhatt DL, Januzzi JL, Jr., de Lemos JA, Yancy C, Fonarow GC, and Pandey A, Association of the New Peer Group-Stratified Method With the Reclassification of Penalty Status in the Hospital Readmission Reduction Program. JAMA Netw Open, 2019. 2(4): p. e192987.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shavers VL, Measurement of socioeconomic status in health disparities research. J Natl Med Assoc, 2007. 99(9): p. 1013-1023.

    PubMed  PubMed Central  Google Scholar 

  11. Bernheim SM, Parzynski CS, Horwitz L, Lin Z, Araas MJ, Ross JS, Drye EE, Suter LG, Normand SL, and Krumholz HM, Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates. Health Aff (Millwood), 2016. 35(8): p. 1461-1470.

    Article  Google Scholar 

  12. Martsolf GR, Barrett ML, Weiss AJ, Kandrack R, Washington R, Steiner CA, Mehrotra A, SooHoo NF, and Coffey R, Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty. J Bone Joint Surg Am, 2016. 98(16): p. 1385-1391.

    Article  PubMed  Google Scholar 

  13. Keyhani S, Myers LJ, Cheng E, Hebert P, Williams LS, and Bravata DM, Effect of clinical and social risk factors on hospital profiling for stroke readmission: a cohort study. Ann Intern Med, 2014. 161(11): p. 775-784.

    Article  PubMed  Google Scholar 

  14. Blum AB, Egorova NN, Sosunov EA, Gelijns AC, DuPree E, Moskowitz AJ, Federman AD, Ascheim DD, and Keyhani S, Impact of socioeconomic status measures on hospital profiling in New York City. Circ Cardiovasc Qual Outcomes, 2014. 7(3): p. 391-397.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Eapen ZJ, McCoy LA, Fonarow GC, Yancy CW, Miranda ML, Peterson ED, Califf RM, and Hernandez AF, Utility of socioeconomic status in predicting 30-day outcomes after heart failure hospitalization. Circ Heart Fail, 2015. 8(3): p. 473-480.

    Article  PubMed  PubMed Central  Google Scholar 

  16. NASEM: Accounting for social risk factors in Medicare payment, available at https://www.nap.edu/download/23635, accessed 2/8/2018. National Academies Press, Washington, DC: National Academies of Sciences, Engineering and Medicine, 2017

  17. Samson LW, Finegold K, Ahmed A, Jensen M, Filice CE, and Joynt KE, Examining Measures of Income and Poverty in Medicare Administrative Data. Med Care, 2017. 55(12): p. e158-e163.

    Article  PubMed  Google Scholar 

  18. Kind AJH and Buckingham WR, Making Neighborhood-Disadvantage Metrics Accessible - The Neighborhood Atlas. N Engl J Med, 2018. 378(26): p. 2456-2458.

    Article  PubMed  PubMed Central  Google Scholar 

  19. US Census Bureau, US Census Bureau: American Community Survey design and methodology,available at https://www2.census.gov/programs-surveys/acs/methodology/design_andmethodology/acs_design_methodology_report_2014pdf2014. Version 2. accessed 5/20/2017. 2014.

  20. Hu J, Kind AJH, and Nerenz D, Area Deprivation Index Predicts Readmission Risk at an Urban Teaching Hospital. Am J Med Qual, 2018. 33(5): p. 493-501.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, Greenberg C, and Smith M, Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med, 2014. 161(11): p. 765-774.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Economic Innovations Group, From great recession to great reshuffling: Charting a decade of change across American communities, findings from the 2018 Distressed Communities Index, available at https://eig.org/wp-content/uploads/2018/10/2018-DCI.pdf. accessed 10/15/2019. 2018.

  23. American College of Surgeons, American College of Surgeons National Quality Improvement Program (ACS NSQIP), available at https://www.facs.org/quality-programs/acs-nsqip. accessed 7/5/2017. 2017.

  24. Shiloach M, Frencher SK, Jr., Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, Richards KE, Ko CY, and Hall BL, Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg, 2010. 210(1): p. 6-16.

    Article  PubMed  Google Scholar 

  25. Kao LS, Dimick JB, Porter GA, and Evidence-Based Reviews in Surgery G, How do administrative data compare with a clinical registry for identifying 30-day postoperative complications? J Am Coll Surg, 2014. 219(6): p. 1187-1191.

    Article  PubMed  Google Scholar 

  26. Lawson EH, Louie R, Zingmond DS, Brook RH, Hall BL, Han L, Rapp M, and Ko CY, A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg, 2012. 256(6): p. 973-981.

    Article  PubMed  Google Scholar 

  27. Hawkins RB, Charles EJ, Mehaffey JH, Williams CA, Robinson WP, Upchurch GR, Kern JA, Tracci MC, and Virginias Vascular G, Socioeconomic Distressed Communities Index associated with worse limb-related outcomes after infrainguinal bypass. J Vasc Surg, 2019. 70(3): p. 786-794 e782.

    Article  PubMed  Google Scholar 

  28. Mehaffey JH, Hawkins RB, Charles EJ, Turrentine FE, Kaplan B, Fogel S, Harris C, Reines D, Posadas J, Ailawadi G, Hanks JB, Hallowell PT, and Jones RS, Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis. BMJ Qual Saf, 2019.

    Google Scholar 

  29. Mehaffey JH, Hawkins RB, Charles EJ, Turrentine FE, Hallowell PT, Friel C, Jones RS, and Tracci MC, Socioeconomic "Distressed Communities Index" Improves Surgical Risk-adjustment. Ann Surg, 2020. 271(3):470-474. https://doi.org/10.1097/SLA.0000000000002997.

  30. Mehaffey JH, Hawkins RB, Charles EJ, Sahli ZT, Schirmer BD, and Hallowell PT, Socioeconomically Distressed Communities Associated With Long-term Mortality After Bariatric Surgery. J Surg Res, 2019. 243: p. 8-13.

    Article  PubMed  Google Scholar 

  31. Mehaffey JH, Hawkins RB, Charles EJ, Thibault D, Williams ML, Brennan M, Thourani VH, Badhwar V, and Ailawadi G, Distressed communities are associated with worse outcomes after coronary artery bypass surgery. J Thorac Cardiovasc Surg, 2019. https://doi.org/10.1016/j.jtcvs.2019.06.104.

  32. University Health System, University Health System, Bexar County, San Antonio Texas, available at https://www.universityhealthsystem.com/, accessed 04/05/2020. 2020.

  33. Arya S, Varley P, Youk A, Borrebach JA, Perez S, Massarweh NN, Johanning JM, and Hall DE, Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assesment Tool. Ann Surg, 2019. https://doi.org/10.1097/SLA.0000000000003276.

  34. Hall DE, Arya S, Schmid KK, Blaser C, Carlson MA, Bailey TL, Purviance G, Bockman T, Lynch TG, and Johanning J, Development and Initial Validation of the Risk Analysis Index for Measuring Frailty in Surgical Populations. JAMA Surg, 2017. 152(2): p. 175-182.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dindo D, Demartines N, and Clavien PA, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004. 240(2): p. 205-213.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Charlson ME, Pompei P, Ales KL, and MacKenzie CR, A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987. 40(5): p. 373-383.

    Article  CAS  PubMed  Google Scholar 

  37. Powers BD, Fulp W, Dhahri A, DePeralta DK, Ogami T, Rothermel L, Permuth JB, Vadaparampil ST, Kim JK, Pimiento J, Hodul PJ, Malafa MP,Anaya DA, and Fleming JB, The impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume CancerCenter: A Retrospective Cohort Analysis. Ann Surg, 2019. https://doi.org/10.1097/SLA.0000000000003706.

  38. University Health System, CareLink, available at https://www.universityhealthsystem.com/patients/support/carelink. accessed 04/05/2020. 2020.

  39. Cologne KG, Keller DS, Liwanag L, Devaraj B, and Senagore AJ, Use of the American College of Surgeons NSQIP Surgical Risk Calculator for Laparoscopic Colectomy: how good is it and how can we improve it? J Am Coll Surg, 2015. 220(3): p. 281-286.

    Article  PubMed  Google Scholar 

  40. Adegboyega TO, Borgert AJ, Lambert PJ, and Jarman BT, Applying the National Surgical Quality Improvement Program risk calculator to patients undergoing colorectal surgery: theory vs reality. Am J Surg, 2017. 213(1): p. 30-35.

    Article  PubMed  Google Scholar 

  41. Samson P, Robinson CG, Bradley J, Lee A, Broderick S, Kreisel D, Krupnick AS, Patterson GA, Puri V, Meyers BF, and Crabtree T, The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg, 2016. 151(3): p. 697-705 e691.

    Article  PubMed  Google Scholar 

  42. Rivard C, Nahum R, Slagle E, Duininck M, Isaksson Vogel R, and Teoh D, Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy. Gynecol Oncol, 2016. 141(2): p. 281-286.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Prasad KG, Nelson BG, Deig CR, Schneider AL, and Moore MG, ACS NSQIP Risk Calculator: An Accurate Predictor of Complications in Major Head and Neck Surgery? Otolaryngol Head Neck Surg, 2016. 155(5): p. 740-742.

    Article  PubMed  Google Scholar 

  44. Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, and Boult C, Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist, 2008. 48(4): p. 495-504.

    Article  PubMed  Google Scholar 

  45. Dupre ME, Xu H, Granger BB, Lynch SM, Nelson A, Churchill E, Willis JM, Curtis LH, and Peterson ED, Access to routine care and risks for 30-day readmission in patients with cardiovascular disease. Am Heart J, 2018. 196: p. 9-17.

    Article  PubMed  Google Scholar 

  46. Telem DA, Yang J, Altieri M, Patterson W, Peoples B, Chen H, Talamini M, and Pryor AD, Rates and Risk Factors for Unplanned Emergency Department Utilization and Hospital Readmission Following Bariatric Surgery. Ann Surg, 2016. 263(5): p. 956-960.

    Article  PubMed  Google Scholar 

  47. Strom JB, Kramer DB, Wang Y, Shen C, Wasfy JH, Landon BE, Wilker EH, and Yeh RW, Short-term rehospitalization across the spectrum of age and insurance types in the United States. PLoS One, 2017. 12(7): p. e0180767.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Turrentine FE, Buckley PJ, Sohn MW, and Williams MD, Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions. Am Surg, 2017. 83(6): p. 573-582.

    Article  PubMed  Google Scholar 

  49. Kelley KA, Young JI, Bassale S, Herzig DO, Martindale RG, Sheppard BC, Lu KC, and Tsikitis VL, Travel distance influences readmissions in colorectal cancer patients-what the primary operative team needs to know. J Surg Res, 2018. 227: p. 220-227.

    Article  PubMed  Google Scholar 

  50. Havens JM, Olufajo OA, Cooper ZR, Haider AH, Shah AA, and Salim A, Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery. JAMA Surg, 2016. 151(4): p. 330-336.

    Article  PubMed  Google Scholar 

  51. DataUSA, San Antonio, TX, available at https://datausa.io/profile/geo/san-antonio-tx/. accessed 2/2/2020.

  52. Vega WA, Rodriguez MA, and Gruskin E, Health disparities in the Latino population. Epidemiol Rev, 2009. 31: p. 99-112.

    Article  PubMed  Google Scholar 

  53. Zogg CK, Pawlik TM, and Haider AH, Three Common Methodological Issues in Studies of Surgical Readmission Rates: The Trouble With Readmissions. JAMA Surg, 2018. 153(12): p. 1074-1076.

    Article  PubMed  Google Scholar 

  54. Fish DR, Mancuso CA, Garcia-Aguilar JE, Lee SW, Nash GM, Sonoda T, Charlson ME, and Temple LK, Readmission After Ileostomy Creation: Retrospective Review of a Common and Significant Event. Ann Surg, 2017. 265(2): p. 379-387.

    Article  PubMed  Google Scholar 

  55. Bliss LA, Maguire LH, Chau Z, Yang CJ, Nagle DA, Chan AT, and Tseng JF, Readmission After Resections of the Colon and Rectum: Predictors of a Costly and Common Outcome. Dis Colon Rectum, 2015. 58(12): p. 1164-1173.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Wahl TS and Hawn MT, How to Predict 30-Day Readmission. Adv Surg, 2018. 52(1): p. 101-111.

    Article  PubMed  Google Scholar 

  57. Wahl TS and Hawn MT, How Do We Prevent Readmissions After Major Surgery? Adv Surg, 2017. 51(1): p. 89-100.

    Article  PubMed  Google Scholar 

  58. Hollis RH, Graham LA, Richman JS, Morris MS, Mull HJ, Wahl TS, Burns E, Copeland LA, Telford GL, Rosen AK, Itani KF, Whittle J, Wagner TH, and Hawn MT, Hospital Readmissions after Surgery: How Important Are Hospital and Specialty Factors? J Am Coll Surg, 2017. 224(4): p. 515-523.

    Article  PubMed  Google Scholar 

  59. Graham LA, Wagner TH, Richman JS, Morris MS, Copeland LA, Harris AH, Itani KM, and Hawn MT, Exploring Trajectories of Health Care Utilization Before and After Surgery. J Am Coll Surg, 2019. 228(1): p. 116-128.

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by National Institutes of Health grants U01TR002393, UL1TR002645, and T32HL07446.

Author information

Authors and Affiliations

  1. Long School of Medicine, Departments of Surgery, Population Health Sciences and Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7741, San Antonio, TX, 78229-3900, USA

    Federico M. Ghirimoldi, Susanne Schmidt, Richard C. Simon, Chen-Pin Wang, Zhu Wang, Bradley B. Brimhall, Eric E. Moffett, Laura S. Manuel, Zaheer U. Sarwar & Paula K. Shireman

  2. South Texas Veterans Health Care System, San Antonio, TX, USA

    Chen-Pin Wang & Paula K. Shireman

  3. University Health System, San Antonio, TX, USA

    Bradley B. Brimhall & Paula K. Shireman

  4. McCombs School of Business, Department of Information, Risk, & Operations Management, University of Texas, Austin, TX, USA

    Paul Damien

Authors
  1. Federico M. Ghirimoldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susanne Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard C. Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chen-Pin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bradley B. Brimhall
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Damien
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eric E. Moffett
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura S. Manuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zaheer U. Sarwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paula K. Shireman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paula K. Shireman.

Ethics declarations

Disclaimer

The views expressed are those of the authors and do not represent the views of the National Institutes of Health. The National Institutes of Health did not play any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghirimoldi, F.M., Schmidt, S., Simon, R.C. et al. Association of Socioeconomic Area Deprivation Index with Hospital Readmissions After Colon and Rectal Surgery. J Gastrointest Surg 25, 795–808 (2021). https://doi.org/10.1007/s11605-020-04754-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-020-04754-9

Keywords

Search

Navigation