Young adults with SLE at higher risk of 30-day rehospitalization

A Medicare cohort study has found a very high 30-day rehospitalization rate among young adults with systemic lupus erythematosus (SLE).

In 2014, a team of researchers calculated 20-percent national Medicare sample of hospitalizations, rehospitalization risk, and mortality within 30 days of discharge for young (aged 18‒35 years), middle-aged (aged 36‒64 years), and older (aged ≥65 years) beneficiaries with and without SLE.

The research team used multivariable generalized estimating equation models to predict rehospitalization rates among SLE patients by age group using patient, hospital, and geographic factors.

A total of 1.39 million Medicare hospitalizations were identified, of which 10,868 had SLE. Hospitalized young adult beneficiaries with SLE were more racially diverse, living in more disadvantaged areas, and had more comorbidities compared with older beneficiaries with SLE and those without SLE.

The rate of rehospitalization within 30 days of discharge was 36 percent among young adult beneficiaries with SLE. This was 40-percent higher than those without SLE and 85-percent higher than older beneficiaries with SLE.

The likelihood of being rehospitalized in all age groups increased with longer length of stay and higher comorbidity risk score. On the other hand, 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,” the researchers said.

“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,” they pointed out.