How Patients’ Income Impacts Hospital Readmissions in AML

Hospital readmissions can measure the quality of care provided to patients. Unplanned readmissions can affect patient outcomes, and they also cost the U.S. healthcare system an estimated $15-20 billion annually. Cancer patients, including those undergoing AML treatment, experience high readmission rates, ranging from 30% to 60%. The readmission burden is more significant for patients with lower socioeconomic status, showing the need to address income-based disparities in care.

We had the privilege of interviewing the lead investigator and presenter of this important study, Dr. Ayobami Olafimihan, who discussed how social and economic status and healthcare disparities might result in hospital readmissions and lower quality of care. 

Analyzing a Decade of AML Readmissions in the U.S.

This retrospective analysis used the Nationwide Readmissions Database (NRD) for 2010, 2012, 2014, 2016, and 2018. The study included 181,432 hospitalizations of adult AML patients, stratified by median household income (MHOI):

• Low Income (LIQ)
• Middle Income
• Upper Middle Income
• High Income (HIQ)

Patients were followed for 30 days after discharge to identify all-cause readmissions and also identified those specifically for neutropenic fever. Other factors were also analyzed over time, including age and sex.

1. Rising readmission rates: Overall, 30-day all-cause readmission rates stood at 29.7% across the study period, with a significant upward trend from 2010 to 2018.
2. Age and income disparities: The mean age at the time of readmission was 59.9 years, with older patients more likely to belong to higher income groups.
3. Neutropenic fever readmissions: The overall 30-day neutropenic fever-specific readmission rate was 5.1%, and high-income patients had higher odds of being admitted to the hospital for neutropenic fever compared to low-income patients.
4. Mortality during readmissions declined from 10.0% in 2010 to 7.8% in 2018, reflecting improvements in inpatient care.

How Income Impacts AML Care

This study underscores the disproportionate burden of unplanned readmissions on low-income AML patients and highlights the critical need for interventions tailored to this population. Key recommendations include:

• Transition of Care Programs: to address gaps in care after hospital discharge.
• Targeted Social Support: to cover the specific needs of low-income patients, including financial assistance, transportation, and access to outpatient care.
• Enhanced follow-up care to reduce the risk of complications like neutropenic fever.

Looking Forward

To improve the care throughout a patient's journey it's important to also consider socioeconomic disparities. By addressing them, patient outcomes can be improved, reduce healthcare costs, and bridge gaps in care for vulnerable populations. It is the job of healthcare professionals to recognize disparities and provide equal care that improves patient outcomes. For patients, self-advocacy is crucial, and understanding disparities can make a big impact when discussing the best treatment options and strategies. This study offers a roadmap for prioritizing socioeconomic factors in AML care strategies and calls for further research to implement effective, equitable solutions.

Keeping up to date with AML news and research is one step further into self-advocacy and advancements in patient-centered care. That’s why at HealthTree, we provide comprehensive updates for patients and caregivers. 

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