Cited by 25Dementia and Cognitive Impairment ResearchHealth disparities and outcomesHealthcare Policy and Management

Disparities in 30‐day readmission rates among Medicare enrollees with dementia

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Gilmore‐Bykovskyi, Andrea, Zuelsdorff, Megan, Block, Laura, Golden, Blair, Kaiksow, Farah, Sheehy, Ann M., Bartels, Christie M., Kind, Amy J. H. +1 more·2023·Journal of the American Geriatrics Society

Abstract

Background: Readmissions contribute to excessive care costs and burden for people living with dementia. Assessments of racial disparities in readmissions among dementia populations are lacking, and the role of social and geographic risk factors such as individual‐level exposure to greater neighborhood disadvantage is poorly understood. We examined the association between race and 30‐day readmissions in a nationally representative sample of Black and non‐Hispanic White individuals with dementia diagnoses. Methods: This retrospective cohort study used 100% Medicare fee‐for‐service claims from all 2014 hospitalizations nationwide among Medicare enrollees with dementia diagnosis linked to patient, stay, and hospital factors. The sample consisted of 1,523,142 hospital stays among 945,481 beneficiaries. The relationship between all cause 30‐day readmissions and the explanatory variable of self‐reported race (Black, non‐Hispanic White) was examined via generalized estimating equations approach adjusting for patient, stay, and hospital‐level characteristics to model 30‐day readmission odds. Results: Black Medicare beneficiaries had 37% higher readmission odds compared to White beneficiaries (unadjusted OR 1.37, CI 1.35–1.39). This heightened readmission risk persisted after adjusting for geographic factors (OR 1.33, CI 1.31–1.34), social factors (OR 1.25, CI 1.23–1.27), hospital characteristics (OR 1.24, CI 1.23–1.26), stay‐level factors (OR 1.22, CI 1.21–1.24), demographics (OR 1.21, CI 1.19–1.23), and comorbidities (OR 1.16, CI 1.14–1.17), suggesting racially‐patterned disparities in care account for a portion of observed differences. Associations varied by individual‐level exposure to neighborhood disadvantage such that the protective effect of living in a less disadvantaged neighborhood was associated with reduced readmissions for White but not Black beneficiaries. Conversely, among White beneficiaries, exposure to the most disadvantaged neighborhoods associated with greater readmission rates compared to White beneficiaries residing in less disadvantaged contexts. Conclusions: There are significant racial and geographic disparities in 30‐day readmission rates among Medicare beneficiaries with dementia diagnoses. Findings suggest distinct mechanisms underlying observed disparities differentially influence various subpopulations.

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  • Inconsistencies in the standard of care from admission and during the hospital stay were associated with reduced patient wellbeing and potential inequitable access to care, which increased the risk of readmission.

    “Inconsistencies in the standard of care from admission and during the hospital stay (potentially explained in part by a lack of standardised information exchange) were associated with reduced patient wellbeing and potential inequitable access to care, which increased the risk of readmission [28, 39–43].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [41]

    The Discussion (pp. 9–10) reports disparities in readmission and suggests that differences in care quality, access, or treatment may contribute. It does not establish inconsistencies in care from admission through the hospital stay, reduced patient wellbeing caused by those inconsistencies, or the claimed causal chain to readmission. The discussion of hospital care quality is explicitly tentative. (LLM, conf=0.84)

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  • Pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled healthcare professionals' beliefs about patients with MLTCiD.

    “Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [41]

    The length-of-stay table (p. 18) reports longer index hospitalizations for Black than for non-Hispanic White Medicare enrollees with dementia (6.2 versus 5.3 days). It does not compare patients with dementia against patients without dementia, so it does not establish that older adults with dementia typically stay longer in hospital. The Discussion (p. 8) considers possible provider bias but does not link beliefs to occupancy targets or pressure to minimise length of stay. (LLM, conf=0.78)

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  • Older adults with dementia typically stay longer in hospital.

    “Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”

    From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [41]

    The Results (p. 6) report that Black beneficiaries with dementia had hospital stays about one day longer than non-Hispanic White beneficiaries with dementia. The length-of-stay table (p. 18) likewise compares groups within the dementia cohort; neither passage establishes that older adults with dementia typically stay longer than older adults without dementia. Searched for a dementia-versus-no-dementia length-of-stay comparison. (LLM, conf=0.76)

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Research works printed but not linked: 1

  1. [46]46. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health C. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press (US) Copyright 2002 by the National Academy of Sciences. All rights reserved. 2003.

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Authors
Gilmore‐Bykovskyi, A., Zuelsdorff, M., Block, L., Golden, B., Kaiksow, F., Sheehy, A. M., Bartels, C. M., Kind, A. J. H., & Powell, W. R.
Affiliations
University of Wisconsin–Madison (US)
Corresponding author
Gilmore‐Bykovskyi, Andrea
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2023-03-10
Volume
71
Issue
7
Pages
2194-2207
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
OpenAlex
W4323807482
Cited by
25
References
66
Citations by year
2026: 5 · 2025: 6 · 2024: 8 · 2023: 6
FWCI
5.07
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Geriatrics Society (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Minority Health and Health Disparities (1R01MD010243‐01, 3R01MD010243‐04S1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
dementia, 30-day readmission, racial disparities, Medicare beneficiaries, Black patients, neighborhood disadvantage, geographic disparities, social determinants of health, hospitalization outcomes, comorbidities
MeSH terms
White, Aged, Dementia, Medicare, Humans, Patient Readmission, Retrospective Studies, United States, Healthcare Disparities

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