Comorbid Conditions Related to Readmissions of Chinese Older Patients
China is the most populous country in the world and is aging at an unprecedented rate. As of 2020, the population of China was approximately 1.4 billion, with 17.30% of the population aged 60 years and older in 2017. This proportion is expected to rise to 35% by 2050. Older age is closely associated with multimorbidity, a condition where individuals suffer from multiple chronic diseases simultaneously. In the United States, 65% of men and 72% of women aged 65 years and older had at least two chronic conditions in 2010. Similarly, older adults in China with multiple chronic conditions are more likely to be readmitted to hospitals after discharge, leading to increased healthcare expenditures and greater utilization of medical resources. While many studies have focused on readmission rates among elderly patients, most have examined single diseases rather than the impact of chronic comorbid conditions on readmissions. Additionally, the majority of these studies have been conducted in the United States, with limited research on Chinese populations due to the lack of large-scale data. Understanding the common chronic comorbid conditions and their changes from initial hospitalization to readmission is crucial for developing effective intervention strategies to reduce avoidable readmissions.
To address this gap, a retrospective cohort study was conducted using inpatient records from the China National Social Health Insurance System (NSHIS) database in a major metropolitan area in Western China. The study included patients aged 65 years and older who were discharged between January 1, 2014, and December 31, 2014. Patients who died during the initial hospitalization were excluded. For patients who were discharged and readmitted on the same day, the two hospitalizations were merged into one. If a patient had multiple readmissions, only the first readmission was considered when calculating the time to readmission. The study analyzed patient characteristics, including primary, secondary, and tertiary diagnoses of morbidities, demographic factors such as age and sex, insurance types, and the time lag between discharge and the first readmission.
The study included 515,123 inpatients aged 65 years and older from the 2014 claims data. Among these, 303,464 patients had at least one of 32 chronic conditions, which were selected based on their prevalence in China. A total of 201,372 patients were readmitted in 2014. The readmission rate was higher among patients aged 75 years and older compared to those aged 65 to 74 years. Men had a higher readmission rate than women, despite there being more women in the study population. The most common chronic conditions among the patients were hypertension and chronic obstructive pulmonary disease (COPD), with 129,327 and 103,807 patients, respectively, having these conditions among their first three diagnoses.
The study identified the top ten chronic comorbid conditions at the initial hospitalization and readmission. Among all older patients, COPD was the most frequently observed condition (10.83%), followed by hypertension (8.42%), stroke (4.26%), diabetes (3.59%), and ischemic heart disease (IHD) (2.91%). Among readmitted patients, the top five chronic comorbid conditions were COPD (13.42%), hypertension (6.88%), stroke (3.62%), diabetes (3.49%), and IHD (3.15%). For patients without readmissions, the most common conditions were hypertension (9.41%), COPD (9.16%), stroke (4.67%), diabetes (3.65%), and a combination of hypertension and diabetes (3.13%).
The study further explored the changes in chronic comorbid conditions from initial hospitalization to the first readmission. Among 27,033 readmitted patients with COPD, 38.12% were readmitted due to the recurrence of COPD. Similarly, the readmission rates due to the recurrence of chronic disease were 38.34% for hypertension, 25.67% for stroke, 54.78% for diabetes, and 28.66% for IHD. Some patients were readmitted with additional chronic conditions. For example, 8.09% of COPD patients were readmitted due to the co-occurrence of COPD and pulmonary heart disease, while 8.02% of diabetic patients were readmitted due to the co-occurrence of hypertension and diabetes. Interestingly, 4.32% of stroke patients had their diagnosis changed to COPD during the first readmission, and 2.79% of COPD patients were readmitted due to the occurrence of hypertension within one year.
The study also calculated the 10th, 25th, and 50th percentile times to readmission for the top ten chronic comorbid conditions using Kaplan-Meier analysis. Among these conditions, diabetes and cancer had the shortest times to readmission. For patients with COPD, diabetes, and IHD, men and patients aged 75 years and older had shorter median times to readmission compared to women and younger patients. Interestingly, for cancer patients, men and those aged between 65 and 74 years had a shorter median time to readmission compared to older patients.
The findings of this study highlight the importance of managing chronic comorbid conditions to reduce hospital readmissions among older patients in China. COPD, hypertension, stroke, diabetes, and IHD were identified as the most common chronic conditions leading to readmissions. The recurrence of these conditions was the primary reason for readmission, emphasizing the need for effective disease management strategies. The study also revealed that men and older patients had shorter times to readmission, suggesting that targeted interventions should be developed for these high-risk groups.
The results of this study have several implications for healthcare policy and practice in China. First, readmission reduction projects, similar to those implemented in developed countries, should be introduced in China, with a focus on managing the most common chronic conditions such as COPD, hypertension, diabetes, and cancer. Second, value-based payment programs could be established to incentivize hospitals to improve the quality of care and reduce unnecessary readmissions. Finally, team-based approaches involving physicians, nurses, therapists, and nutritionists can provide coordinated care to both inpatients and outpatients, while also offering essential education on self-management and nutrition, particularly for high-risk patients.
In conclusion, this large-scale retrospective study provides valuable insights into the chronic comorbid conditions associated with hospital readmissions among older patients in China. By identifying the most common conditions and the factors contributing to readmissions, the study offers a foundation for developing targeted interventions to improve patient outcomes and reduce healthcare costs. The findings underscore the need for a comprehensive approach to chronic disease management, with a focus on preventing disease recurrence and addressing the unique needs of high-risk populations.
doi.org/10.1097/CM9.0000000000001854
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