Cumulative social determinants of health burden increased 30-day readmission risk in COPD patients, with four factors yielding a 2.4-fold higher risk (aRR 2.36; 95% CI 1.22-4.56; p=0.010).
Cohort (n=250)
No
Does the presence of social determinants of health increase 30-day readmission risk in adults hospitalized for COPD exacerbation?
Social determinants of health, including housing instability, financial difficulties, and food insecurity, are independently and cumulatively associated with an increased risk of 30-day readmission in patients with COPD.
Effect estimate: aRR 2.36 (95% CI 1.22-4.56)
p-value: p=0.010
Abstract Rationale Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity with high readmission rates. Social determinants of health (SDOH) such as food, housing, and financial insecurity, and transportation barriers, impact disease management, but their effect on COPD readmissions is underexplored. Additionally, smoking, substance use, and language barriers may worsen outcomes. This study aimed to assess the association between SDOH and 30-day readmission risk following COPD exacerbation hospitalization. Methods We conducted a retrospective cohort study with 291 adults hospitalized for COPD exacerbation at Lincoln Hospital between November/2024 and July/2025. Primary exposures included four SDOH categories (housing instability, transportation, financial difficulties, and food insecurity), smoking history, substance use, and preferred language. The primary outcome was 30-day readmission rate. After accounting for missingness, a total of 250 patients remained in the study. Unadjusted and age- and race-adjusted relative risks (RR) were calculated using modified Poisson regression with robust variance, given the non-rare outcome. Each SDOH factor was analyzed separately. We assessed cumulative SDOH burden using a count variable (0-4) and compared each level to absence of SDOH barriers. Statistical significance was set at p 0.05. Results Among 250 participants (mean age 41-65 years, 51.6% female, 53.2% Hispanic), 46 (18.4%) experienced 30-day readmission. In unadjusted analyses, housing instability (RR 1.77, 95% CI 1.00-3.12, p = 0.04), financial difficulties (RR 2.58, 95% CI 1.54-4.31, p 0.001), and food insecurity (RR 2.01, 95% CI 1.18-3.41, p = 0.010) were associated with increased readmission risk. After adjusting for age and race, housing instability (aRR 1.93, 95% CI 1.10-3.38, p = 0.02), financial difficulties (aRR 2.71, 95% CI 1.64-4.50, p 0.001), and food insecurity (aRR 2.07, 95% CI 1.21-3.54, p = 0.008) remained significant. Likewise, substance use was significantly associated with hospital readmission in both models (RR 2.13, 95% 1.23-3.66, p = 0.007; aRR 2.36, 95% CI 1.37-4.05, p = 0.002). In adjusted analyses, cumulative SDOH burden demonstrated a clear dose-response relationship. Compared to no SDOH barriers, participants with two factors had a 2.3-fold higher risk of the outcome (adjusted RR = 2.26, 95% CI 0.91-5.59, p = 0.079), three factors had a 3-fold higher risk (adjusted RR = 3.01, 95% CI 1.35-6.71, p = 0.007), and four factors had a 2.4-fold higher risk (adjusted RR = 2.36, 95% CI 1.22-4.56, p = 0.010). Conclusion We found that SDOH are independently and cumulatively linked to increased 30-day readmission risk in COPD patients. These findings suggest that effective readmission prevention strategies should address SDOH to improve long-term outcomes. This abstract is funded by: None
Pelanda et al. (Fri,) conducted a cohort in Chronic obstructive pulmonary disease (COPD) (n=250). Social determinants of health (SDOH) barriers vs. Absence of SDOH barriers was evaluated on 30-day readmission (aRR 2.36, 95% CI 1.22-4.56, p=0.010). Cumulative social determinants of health burden increased 30-day readmission risk in COPD patients, with four factors yielding a 2.4-fold higher risk (aRR 2.36; 95% CI 1.22-4.56; p=0.010).