Urban–rural classification and readmission risk estimates in younger adults with ischaemic stroke: a secondary analysis

AIMS: Hospital readmissions following ischaemic stroke remain a serious concern in cardiovascular care, particularly among younger adults whose recovery needs differ from older populations. This study examined predictors of 30-day readmission among stroke survivors aged 19-64 years, with a focus on how different rural-urban classifications influence estimated associations between geography and readmission outcomes. METHODS AND RESULTS: We conducted a retrospective secondary analysis of hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient Databases (2012-15) for six US states. The sample included 85 667 adults aged 19-64 years hospitalized for acute ischaemic stroke. Geographic location was operationalized using multiple rural-urban classifications derived from Urban Influence Codes. Multivariable logistic regression models assessed predictors of planned and unplanned 30-day readmission.Geographic location was not a consistent predictor of readmission across alternative rurality definitions. Living in a large metropolitan area was associated with slightly higher odds of unplanned readmission when compared with other locations (adjusted odds ratio 1.06; 95% CI 1.00-1.12), but this association was not observed when alternative rural-urban classifications were applied. Across models, significant predictors of readmission included age, payer type, length of stay, and number of chronic conditions. CONCLUSION: Associations between geographic location and stroke readmission outcomes varied depending on how rural-urban classifications were defined. These findings highlight the importance of methodological clarity when interpreting geographic effects in secondary analyses of administrative data and have implications for cardiovascular nurses involved in discharge planning and transitional care for younger stroke survivors.