Racial and Ethnic Differences in 60-Day Hospital Readmissions for Patients with Breast, Colorectal, Lung, and...

This study evaluates factors associated with racial/ethnic differences in 60-day hospital readmissions for patients with the four most common cancer types.

The cohort included 43,781 patients discharged alive following an index admission with a principal diagnosis of breast, colorectal, lung, or prostate cancer in the 2016 State Inpatient Database from the Healthcare Cost and Utilization Project. Multivariate logistic regression models were utilized to evaluate contributors to differences in 60-day hospital readmissions and to estimate Peters-Belson observed-to-expected (OE) 60-day readmission rate ratios for each race/ethnicity.

Black patients had higher odds of 60-day readmissions for all four cancer types combined (OR, 1.14; 95% CI, 1.04-1.25) and for prostate cancer (OR, 1.19; 95% CI, 1.02-1.40). For all four cancer types combined, residence in a lower-income ZIP code and Medicaid insurance was associated with higher OE rate ratio for 60-day readmissions among Black and Hispanic patients. Black patients with prostate (OE ratio 1.23; 95% CI, 1.08-1.41), and breast cancer (OE ratio 1.29; 95% CI, 1.07-1.56), and Hispanic patients with breast cancer (OE ratio 1.29; 95% CI, 1.03-1.61) in the highest income quartile had higher OE rate ratios. Investor-owned hospitals were associated with higher OE rate ratios for White patients with prostate cancer and all patients with lung cancer.

Racial and ethnic differences in 60-day hospital readmission rates for patients with the most common cancer types are driven by multiple patient- and hospital-level factors. Identifying these factors is the first step in developing strategies to improve the quality of cancer care.