High hospital readmission rates for patients aged >= 65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care

Objective: There is a presumption that hospital readmission rates amongst persons aged >= 65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged >= 65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission. Design: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses. Setting and subjects: Register data of 283,063 patients in 29 primary health care centres in the Region orebro County (Sweden) in 2014. Main outcome measure: Thirty-day hospital readmission rates for patients aged >= 65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload. Results: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r=0.74; p<0.001), proportion unemployed (r=0.73; p<0.001), Care Need Index (r=0.74; p<0.001), sick leave rate (r=0.51; p<0.01) and average income (r=-0.40; p=0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p<0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies. Conclusion: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged >= 65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities.