Alison Blodgett, Jonathan Guerrero, Baraka Muvuka

Food Insecurity: An Upstream Social Determinant of 30-Day Congestive Heart Failure Readmissions

Introduction

Food insecurity: an upstream social determinant of 30-day congestive heart failure readmissions . Food insecurity is a critical upstream social determinant predicting 30-day congestive heart failure (CHF) readmissions. Learn its significant impact on patient outcomes and healthcare costs.

Abstract

Background:   Approximately 6.7 million Americans have congestive heart failure (CHF), costing the healthcare system over $30 billion annually. Readmissions contribute significantly to these costs, as 20-25% of hospitalized CHF patients are readmitted within 30 days of discharge. The Hospital Readmissions Reduction Program monitors 30-day readmission rates and penalizes hospitals that do not meet targets. Previous research on factors impacting CHF readmissions has largely focused on downstream factors such as race, ethnicity, sex, and clinical practices rather than upstream factors that can potentially inform high-impact interventions. This study explored downstream, midstream, and upstream factors—including demographics, social determinants of health (SDOH), and health behaviors—and their relationship with 30-day CHF readmissions in an urban healthcare system in Northwest Indiana. This was part of an academic-health system participatory research partnership.  Methods:   This retrospective study analyzed a limited dataset from EPIC™ with SDOH, demographic, health behavior, and health outcomes of adult inpatients between January 2021 and April 2024. Data analysis consisted of descriptive, bivariate (Chi-Square; p<0.05), and multivariate (Binary Logistic Regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040).   Results:   The sample consisted of 5,489 patients with CHF, predominantly White (63.8%), 65+ years old (76.2%), and publicly insured (91.8%). 30-day readmissions represented 22.4% of CHF admissions. The bivariate analysis revealed significant associations between 30-day CHF readmissions and ethnicity (p=.003), sex (p=.046), language (p=.017), hospital (p=.009), insurance type (p=.003), food insecurity (p=.048), and depression risk (p=.003). Food insecurity remained significantly associated with 30-day CHF readmission (OR=2.128; p=.033) after adjusting for these factors in the multivariate analysis.  Conclusion:   This study identified food insecurity as an upstream SDOH predicting 30-day CHF readmission. Future research should further explore other upstream factors contributing to 30-day CHF readmissions and evaluate evidence-based food insecurity interventions.  

Review

This study tackles a highly pertinent issue in healthcare: the significant burden and cost associated with 30-day congestive heart failure (CHF) readmissions. Departing from conventional research that often scrutinizes downstream clinical and demographic factors, this paper commendably shifts its focus to upstream social determinants of health (SDOH), particularly food insecurity. By examining a comprehensive array of demographic, midstream, and upstream factors within an urban healthcare system, the authors aim to identify high-impact intervention points, offering a crucial new perspective on strategies to reduce costly and detrimental readmission rates. The researchers employed a retrospective design, analyzing a substantial dataset from EPIC™ encompassing 5,489 adult inpatients with CHF. The study sample was largely characterized by older, predominantly White, and publicly insured individuals, with a 30-day readmission rate of 22.4%, consistent with national averages. Through a combination of descriptive, bivariate, and multivariate analyses, the study identified several factors significantly associated with readmissions, including ethnicity, sex, language, hospital, insurance type, and depression risk. Most notably, after adjusting for these variables in the multivariate model, food insecurity emerged as a robust and independent predictor of 30-day CHF readmission (OR=2.128; p=.033), highlighting its critical upstream influence. The identification of food insecurity as a potent upstream SDOH predicting 30-day CHF readmissions represents a significant and actionable finding. This insight strongly suggests that integrating routine screening for food insecurity and developing targeted interventions could be a highly effective strategy for healthcare systems to reduce readmission rates and improve patient outcomes. The study effectively advocates for a broader, more holistic approach to CHF management that extends beyond traditional clinical practices to address fundamental social needs. The authors appropriately recommend future research to further explore other upstream factors and, crucially, to evaluate the efficacy of evidence-based interventions designed to combat food insecurity among CHF patients.

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