59 - Clinical and Social Determinants of Readmissions in Children with Chronic Kidney Disease

Chronic kidney disease (CKD) is a multi-system disorder with unique physical and psychological demands in the pediatric population. The high readmission rates in adult CKD patients have prompted the development of interventions identifying “at-risk” individuals. However, there is limited knowledge on readmission risk factors for children with CKD. Here we describe intervenable and non-intervenable risk factors for pediatric CKD patients who have had a 30-day readmission.

Objective:

To investigate clinical and social determinants of health (SDH) factors associated with an increased risk of 30-day readmission, as well as using the Childhood Opportunity Index (COI) in the pediatric CKD population

Design/Methods:

The Pediatric Health Information System (PHIS) database was utilized to perform a multi-center, retrospective cohort study with the following inclusion criteria: pediatric patients < 19 years old, admission to a PHIS hospital between January 1, 2016-June 30, 2021, and CKD diagnosis based on ICD-10 codes. Exclusion criteria included transplant status, an index admission resulting in death, or elective readmission. Logistic regression models were used to analyze risk factors associated with a 30-day readmission.

Results:

A total of 50,718 pediatric patients with 6,248 (12.3%) readmissions were identified. Readmitted patients were likely to be non-White, have a complex chronic condition, mental health co-morbidity, public insurance, and longer length of stay. Multivariable logistic regression found that being of Asian race (OR 1.24; 95%CI: 1.08-1.42), Hispanic/Latino ethnicity (OR 1.07; 95% CI:1.01-1.15), having CKD stage 5 (OR 1.46; 95% CI 1.31-1.63), a longer length of stay (OR 1.69; 95% CI: 1.58-1.80), and higher medical complexity score (OR 7.07; 95% CI: 5.20-9.62) were significantly associated with a readmission (Table 1). After adjustment of clinical and social determinant of health factors, having a mental health co-morbidity continued to be associated with a 30-day readmission (OR 1.10; 95% Cl: 1.03-1.17). The COI was not found to be significant.

Conclusion(s):

Co-morbid mental health conditions, being of Asian race, and Hispanic/Latino ethnicity were associated with a higher risk of readmission in adjusted analyses. These results prompt the need for further work in optimization of mental health care and understanding of language and cultural barriers for families of different backgrounds. Future studies include evaluation of in-hospital factors and the patient/family experience to aid in the creation of targeted interventions.