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APHA Scientific Session and Event Listing

Eugene Youjun Wen, MD, DrPH, Indra Pulcins, PhD, Sharon Relova, MSc, and Yana Gurevich, MD, MPH. Research and Indicator Development, Canadian Institute for Health Information (CIHI), 90 Eglinton Ave. East, Suite 300, Toronto, ON M4P 2Y3, Canada, 416-544-5570, ewen@cihi.ca

Background: Previous studies have shown that hospital readmission rates may differ between higher and lower income patients. The purpose of this study was to examine the association of neighborhood income quintiles and readmission rates of AMI (acute myocardial infarction) patients who were hospitalized in Canada. The effect of hospital admission category and reason for readmission (all cause versus cardiac) was also explored.

Methods: Using the Discharge Abstract Database (Canadian Institute for Health Information), AMI patients hospitalized in acute care facilities across Canada between fiscal year 2002 and 2004 were tracked for 28 days after their first discharge date. Using the postal code conversion file (based on the 2001 Census from Statistics Canada), patients' residential postal codes were used to assign neighborhood income quintiles. Logistic regression modeling was used to describe the association between AMI readmission rates and income level, while adjusting for age and sex.

Results: A total of 65,349 qualified AMI patients were identified from the first 11 months of each fiscal year. All cause readmission rate for combined elective and urgent/emergency admission categories was 16.6%, while cardiac readmission rate was 10.6%. There were was no statistically significant difference observed between the lowest and highest income quintiles for readmission rates for combined elective and urgent/emergency admission categories. For urgent/emergency readmissions, all cause readmission rate was 13.6%, and cardiac readmission rate was 8.5%. Patients in the highest income quintile patients had statistically significant lower readmission rates when compared to that of the lowest income quintile group for all cause readmission (OR = 0.8920.9, 95% confidence interval (CI) = 0.829-0.960) and cardiac readmission (OR = 0.887, 95% CI = 0.811-0.970). A decline of readmission rates from lower to higher income quintile was also observed.

Conclusion:This study found that neighborhood income and urgent readmission rates of AMI had a significant association. Lower income patients were more likely to be readmitted when compared to higher income patients. Both primary health care and in-hospital care need to be improved to address this inequality.

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