179 - Increased Hospital Readmission Rates Amongst Children and Youth with Housing Instability

Publication Number: 1168.179

Alyssa Coffin, Boston Children's Hospital, Boston, MA, United States; Jana C. Leary, Boston Children's Hospital, Waban, MA, United States; Kathleen E. Walsh, Boston Children's Hospital, boston, MA, United States; Sara Toomey, Boston Children's Hospital, Cambridge, MA, United States

Background: Family housing instability is prevalent and associated with worse pediatric physical, mental, and developmental health outcomes. However, the effect of housing instability on pediatric hospital utilization outcomes is not well-characterized. For pediatric subpopulations with asthma and diabetes, patients with housing instability are more likely to be readmitted within a year. However, the relationship between housing instability and hospital readmission remains unclear amongst the broader pediatric population and over shorter post-discharge periods.

Objective: To determine whether pediatric housing instability is associated with hospital 30- and 7- day readmission rates in a national cohort.

Design/Methods: This retrospective cohort study used the Healthcare Cost and Utilization Project 2022 National Readmissions Database. We included all hospital admissions for patients under 22 years. We excluded admissions ending in death, birth encounters, elective admissions, or discharge after Nov 30. Primary exposure was housing instability as identified by ICD-10 codes. Primary outcome was 30-day readmission rate. Secondary outcomes were 7-day readmission rate, length of stay, and total charges. We used descriptive statistics to summarize demographic and clinical characteristics by housing instability status. We used multivariate logistic and linear regression to examine the association between housing instability and our outcomes while adjusting for potential confounders.

Results: Of 599,637 index admissions, 6,611 included an ICD-10 code for housing instability. Patients with housing instability were more likely to be older, male, publicly insured, and live in lowest quartile income zip codes (Table 1). Thirty-day readmission rates were 16.4% and 8.7% for those with and without housing instability, respectively (aOR: 2.32, 95% CI: 2.11-2.55). Seven-day readmission rates were 6.9% and 3.2% for those with and without housing instability, respectively (aOR: 2.43, 95% CI: 2.14-2.76) (Figure 1). Age was an effect modifier, with a stronger association between housing instability and readmission rates for infants and young adults (Figure 2). Those with housing instability had similar lengths of stay and lower total charges.

Conclusion(s): Youth with housing instability experience higher rates of 7- and 30-day readmission, particularly infants and young adults. Hospitalizations for youth with housing instability have lower total charges despite similar lengths of stay, potentially due to non-medically necessary hospital days. Targeted interventions are needed to optimize discharges for this vulnerable population.

Table 1: Demographic characteristics of study population comparing patients with and without identified housing instability.


Figure 1: Comparing 7- and 30-Day readmission rates for youth with and without housing instability.


Figure 2: Association between housing instability and adjusted1 odds of 7-Day (left) and 30-Day (right) Readmission, stratified by age.