Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

Figures & data

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram of systematic reviews.

Table 1 Description of the characteristics of the included studies

Source	Study type	Data source (study period)	Study location	Patients, n	Disease of admission	Study outcome	Socioeconomic variables	Follow-up period	Analytic model	Quality score
Krumholz et al 2000^Citation24	Retrospective cohort study	Medicare provider analysis and review; medical records; Hospital administrative data (1994–1995)	USA	2,176	Heart failure	All-cause readmission; heart failure readmission	Race/ethnicity	6 months	Cox proportional hazards regression	82%
Rathore et al 2003^Citation25	Retrospective cohort study	Medical records; Medicare administrative data; American Hospital Association’s Annual Survey (1998–1999)	USA	29,732	Heart failure	All-cause readmission	Race/ethnicity	1 year	Multivariate logistic regression	80%
Schwarz et al 2003^Citation28	Prospective cohort study	Medical records; self report (not given)	USA	156	Heart failure	All-cause readmission	Education	90 days	Cox proportional hazards regression	84%
Rathore et al 2006^Citation29	Retrospective cohort study	Medicare administrative data; medical records (1998–1999)	USA	25,086	Heart failure	All-cause readmission	Socioeconomic status (residence- based socioeconomic information)	1 year	Multilevel variables hierarchical model	95%
Rodríguez-Artalejo et al 2006^Citation30	Prospective cohort study	Medical records; self report (not given)	Spain	371	Heart failure	All-cause readmission	Social network (married, living alone, contact with family daily, stay alone >2 hours)	6 months (on average)	Cox proportional hazards regression	75%
Roe-Prior et al 2007^Citation27	Retrospective cohort study	Self report (interview); randomized controlled trial cohort (1994–2004)	USA	103	Heart failure	All-cause readmission; heart failure readmission	Marital status; income; education	90 days	Multivariate logistic regression	61%
McHugh et al 2010^Citation22	Retrospective cohort study	Medicare provider analysis and review; American Hospital Association’s Annual Survey (2008)	USA	590,114	Heart failure + acute myocardial infarction	All-cause readmission	Race/ethnicity	30 days	Generalized estimating equation models	50%
Joynt et al 2011^Citation14	Retrospective cohort study	Medicare provider analysis and review; American Hospital Association’s Annual Survey (2006–2008)	USA	3,163,011	Acute myocardial infarction + CHF	All-cause readmission	Race/ethnicity	30 days	Multivariate logistic regression	84%
Rodriguez et al 2011^Citation21	Retrospective cohort study	Medicare provider analysis review; American Hospital Association; Hospital Quality Alliance (2006–2008)	USA	1,734,101	Heart failure + acute myocardial infarction	All-cause readmission	Race/ethnicity	30 days	Multivariate logistic regression	84%
Howie-Esquivel et al 2012^Citation23	Retrospective cohort study	Medical records (2009)	USA	809	Heart failure	All-cause readmission	Race/ethnicity; marital status	90 days	Multivariate logistic regression	80%
Lindenauer et al 2013^Citation26	Retrospective cohort study	Medicare administrative data; US Census current population survey and other claims files (2006–2008)	USA	558,200	Acute myocardial infarction + heart failure	All-cause readmission	Income	30 days	Multivariate logistic regression	89%

Abbreviation: CHF, congestive heart failure.

Table 2 The association of socioeconomic factors and readmission

Readmission outcome and socioeconomic factors	Studies	Association	Cumulative effect	Quality score
Short-term outcome (30 days and 90 days)
Race/ethnicity			Positive
Hispanic vs white	Rodriguez et al 2011;^Citation21	+		84%
	McHugh et al 2010^Citation22	+		50%
Black vs white	Joynt et al, 2011;^Citation14	+		84%
	McHugh et al 2010^Citation22	+		50%
Not white (black, Hispanic, Asian) vs white	Howie-Esquivel et al 2012^Citation23	=		80%
Income			Inconclusive but promising
Low quarters of income versus high quarters of income	Lindenauer et al 2013^Citation26	+		89%
Low versus high income	Roe-Prior et al 2007^Citation27	=		61%
Marital status			Positive
Not partnered versus partnered	Howie-Esquivel et al 2012^Citation23	+		80%
Unmarried/widowed versus married	Roe-Prior et al 2007^Citation27	+		61%
Education			No effect
Less than high school versus post-high school	Roe-Prior et al 2007^Citation27	=		61%
Less than high school graduate versus post-high school graduate	Schwarz et al 2003^Citation28	=		84%
Long-term outcome (6 months and 1 year)
Race/ethnicity			Inconclusive but promising
Other versus white	Krumholz et al 2000^Citation24	=		82%
Black versus white	Rathore et al 2003^Citation25	+		80%
Socioeconomic status			Insufficient evidence
Lower versus higher class of socioeconomic status	Rathore et al 2006^Citation29	+		95%
Social network			Insufficient evidence
Moderate/low versus high social network	Rodríguez-Artalejo et al 2006^Citation30	+		75%

Notes: + stands for a positive association and = stands for no association.

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