Socioeconomic disparities in in-hospital mortality and 30-day hospital readmission rates among people with eating disorders: a retrospective cohort study

TL;DR

Higher-income individuals with eating disorders had higher hospital readmission rates but lower in-hospital mortality, suggesting possible differences in access to follow-up care.

Contribution

This study identifies socioeconomic disparities in hospital outcomes for people with eating disorders using a U.S. national sample.

Findings

Admissions from higher-income areas had higher odds of 30-day readmission compared to lower-income areas.

Admissions with Medicaid or private insurance had lower readmission rates compared to those with Medicare.

In-hospital mortality was highest for Medicare-insured admissions and lowest for private insurance.

Abstract

We sought to examine socioeconomic disparities in 30-day hospital readmissions and in-hospital mortality among admissions of people with eating disorders in a U.S. national sample.

Using the 2019 Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD), we analyzed data from 13,986 admissions with a primary or secondary diagnosis of eating disorders. Multivariable logistic regression assessed associations between socioeconomic status (SES), insurance status, and 30-day readmission, as well as in-hospital mortality. SES was categorized into quartiles based on neighborhood median income from patients’ postal codes. Insurance status included Medicare, Medicaid, private insurance, and other. Generalized Estimating Equations (GEE) accounted for facility clustering.

Of 13,986 admissions, 693 were readmissions. Admissions of people with eating disorders in the highest income quartile had significantly higher odds of readmission (OR = 1.60, 95% CI = 1.23–2.10) compared to those in the lowest quartile. Admissions covered by Medicaid (OR = 0.71, 95% CI = 0.57–0.89) or private insurance (OR = 0.66, 95% CI = 0.53–0.83) had lower odds of readmission compared to admissions covered by Medicare. No significant differences in readmission rates were observed across hospitals located in different geographic areas nor across hospitals with differing ownership. In-hospital mortality was highest among admissions of people with eating disorders insured by Medicare (1.35%) and lowest among those with private insurance (0.39%) (OR = 0.48, 95% CI = 0.27–0.84).

People with eating disorders from higher SES backgrounds had higher readmission rates but lower in-hospital mortality, potentially indicating that these people may be receiving a more intensive level of outpatient care. Higher readmission rates may paradoxically indicate continued engagement in follow-up care. However, this interpretation remains speculative and further research is needed to explore the mechanisms behind these disparities, particularly focusing on access to care for people with eating disorders from lower-income backgrounds.

We sought to examine how income and insurance status affect hospital outcomes for people with eating disorders in a 2019 U.S. national sample, focusing on two main outcomes—whether readmission to a hospital occurred within 30 days, and whether an admission ended in death during hospital stay. We found that admissions of people with eating disorders living in higher-income areas were more likely to be readmitted. Separately, we found that admissions of those with Medicaid or private insurance were less likely to be readmitted compared to those with Medicare. Lastly, we found that those with private insurance were less likely to die during their hospital stay compared to those with Medicare. These findings, although speculative, may suggest that people with eating disorders from higher socioeconomic backgrounds may have better access to follow-up care. Further research is needed to understand why these disparities exist, especially focusing on whether or not people with eating disorders from lower socioeconomic backgrounds are able to access the care they need.