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Research ArticleSystemic Lupus Erythematosus

Age-Stratified 30-day Rehospitalization and Mortality and Predictors of Rehospitalization Among Patients With Systemic Lupus Erythematosus: A Medicare Cohort Study

Maria Schletzbaum, Amy J. Kind, Yi Chen, Brad C. Astor, Stacy P. Ardoin, Andrea Gilmore-Bykovskyi, Ann M. Sheehy, Farah A. Kaiksow, W. Ryan Powell and Christie M. Bartels
The Journal of Rheumatology March 2023, 50 (3) 359-367; DOI: https://doi.org/10.3899/jrheum.220025
Maria Schletzbaum
1M. Schletzbaum, PhD, B.C. Astor, PhD, MPH, Department of Population Health Sciences, and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Amy J. Kind
2A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Yi Chen
3Y. Chen, MS, Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Brad C. Astor
1M. Schletzbaum, PhD, B.C. Astor, PhD, MPH, Department of Population Health Sciences, and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Stacy P. Ardoin
4S.P. Ardoin, MD, MS, Division of Pediatric Rheumatology, Nationwide Children’s Hospital, Columbus, Ohio;
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Andrea Gilmore-Bykovskyi
5A. Gilmore-Bykovskyi, PhD, RN, Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, and School of Nursing, University of Wisconsin, Madison, Wisconsin, USA.
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Ann M. Sheehy
2A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Farah A. Kaiksow
2A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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W. Ryan Powell
2A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Christie M. Bartels
2A.J. Kind, MD, PhD, A.M. Sheehy, MD, MS, F.A. Kaiksow MD, MPP, W. Ryan Powell, PhD, MA, C.M. Bartels, MD, MS, Department of Medicine, and Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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  • For correspondence: cb4@medicine.wisc.edu
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Abstract

Objective Recent studies suggest young adults with systemic lupus erythematosus (SLE) have high 30-day readmission rates, which may necessitate tailored readmission reduction strategies. To aid in risk stratification for future strategies, we measured 30-day rehospitalization and mortality rates among Medicare beneficiaries with SLE and determined rehospitalization predictors by age.

Methods In a 2014 20% national Medicare sample of hospitalizations, rehospitalization risk and mortality within 30 days of discharge were calculated for young (aged 18-35 yrs), middle-aged (aged 36-64 yrs), and older (aged 65+ yrs) beneficiaries with and without SLE. Multivariable generalized estimating equation models were used to predict rehospitalization rates among patients with SLE by age group using patient, hospital, and geographic factors.

Results Among 1.39 million Medicare hospitalizations, 10,868 involved beneficiaries with SLE. Hospitalized young adult beneficiaries with SLE were more racially diverse, were living in more disadvantaged areas, and had more comorbidities than older beneficiaries with SLE and those without SLE. Thirty-day rehospitalization was 36% among young adult beneficiaries with SLE—40% higher than peers without SLE and 85% higher than older beneficiaries with SLE. Longer length of stay and higher comorbidity risk score increased odds of rehospitalization in all age groups, whereas specific comorbid condition predictors and their effect varied. Our models, which incorporated neighborhood-level socioeconomic disadvantage, had moderate-to-good predictive value (C statistics 0.67-0.77), outperforming administrative data models lacking comprehensive social determinants in other conditions.

Conclusion Young adults with SLE on Medicare had very high 30-day rehospitalization at 36%. Considering socioeconomic disadvantage and comorbidities provided good prediction of rehospitalization risk, particularly in young adults. Young beneficiaries with SLE with comorbidities should be a focus of programs aimed at reducing rehospitalizations.

Key Indexing Terms:
  • age group
  • cohort study
  • health services research
  • hospital readmission
  • Medicare
  • systemic lupus erythematosus
  • Accepted for publication July 7, 2022.
  • Copyright © 2023 by the Journal of Rheumatology
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Age-Stratified 30-day Rehospitalization and Mortality and Predictors of Rehospitalization Among Patients With Systemic Lupus Erythematosus: A Medicare Cohort Study
Maria Schletzbaum, Amy J. Kind, Yi Chen, Brad C. Astor, Stacy P. Ardoin, Andrea Gilmore-Bykovskyi, Ann M. Sheehy, Farah A. Kaiksow, W. Ryan Powell, Christie M. Bartels
The Journal of Rheumatology Mar 2023, 50 (3) 359-367; DOI: 10.3899/jrheum.220025

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Age-Stratified 30-day Rehospitalization and Mortality and Predictors of Rehospitalization Among Patients With Systemic Lupus Erythematosus: A Medicare Cohort Study
Maria Schletzbaum, Amy J. Kind, Yi Chen, Brad C. Astor, Stacy P. Ardoin, Andrea Gilmore-Bykovskyi, Ann M. Sheehy, Farah A. Kaiksow, W. Ryan Powell, Christie M. Bartels
The Journal of Rheumatology Mar 2023, 50 (3) 359-367; DOI: 10.3899/jrheum.220025
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Keywords

age group
COHORT STUDY
HEALTH SERVICES RESEARCH
HOSPITAL READMISSION
MEDICARE
SYSTEMIC LUPUS ERYTHEMATOSUS

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Keywords

  • age group
  • cohort study
  • health services research
  • hospital readmission
  • Medicare
  • systemic lupus erythematosus

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