Impact of socioeconomic geography on outcomes following hospital discharge for people with diabetes
Keywords:Diabetes, Socioeconomic, Readmission, Hospital Discharge
Background: Socioeconomic factors drive poor diabetes outcomes. Little research has assessed the impact of socio-economic factors on outcomes when people with diabetes are discharged from hospital. We evaluate the impact of socioeconomic factors on readmission and mortality.
Methods: We performed a retrospective evaluation of data extracted from an electronic health record of a large UK hospital for all patients discharged with a diabetes diagnosis over 3 years. Data were extracted for 46,357 distinct discharges and matched at patient level to postcode sector socioeconomic data. Outcomes were evaluated against pre-specified diabetes cohorts. Standardised effect sizes were calculated.
Results: Socioeconomic status was statistically significantly associated with 14 of 19 socioeconomic variables in relation to 180-day mortality for a type 2 diabetes mellitus (T2DM) patient cohort; no statistically significant association between mortality and socioeconomic variables in a type 1 diabetes mellitus (T1DM) cohort was noted. Socioeconomic status was significantly associated with one of 19 variables for 28-day readmission in T2DM patient cohorts compared with nine statistically significant variables for T1DM cohorts. Effect sizes were strongest for deprivation indices (Cohen’s D=0.29) and health-related activity impairment (Cohen’s D=0.15).
Conclusion: There is a strong association between geographical socioeconomic status and readmission outcomes for patients with T1DM but only a limited association with mortality. In contrast, mortality for T2DM cohorts is strongly associated with socioeconomic status whilst readmission is not.
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