Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation

Chest. 2016 Apr;149(4):1021-9. doi: 10.1016/j.chest.2015.12.039. Epub 2016 Jan 21.

Abstract

Background: Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission.

Objectives: To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences.

Methods: Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission.

Results: Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001).

Conclusions: After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.

Keywords: COPD; adults; asthma exacerbation; readmission.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Asthma / epidemiology*
  • California / epidemiology
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Depression / epidemiology
  • Diabetes Mellitus / epidemiology
  • Disease Progression*
  • Ethnicity / statistics & numerical data*
  • Female
  • Florida / epidemiology
  • Heart Failure / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Income / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nebraska / epidemiology
  • Obesity / epidemiology
  • Patient Readmission / statistics & numerical data*
  • Pneumonia / epidemiology*
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Renal Insufficiency / epidemiology
  • Respiratory Insufficiency / epidemiology*
  • Retrospective Studies
  • Substance-Related Disorders / epidemiology
  • Time Factors
  • Young Adult