Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

Elizabeth Scaria, W. Ryan Powell, Jen Birstler, Oguzhan Alagoz, Daniel Shirley, Amy J.H. Kind, Nasia Safdar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as ‘neighborhood’ socioeconomic disadvantage, on a CDI patient’s health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient’s ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. Methods: In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. Results: From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). Conclusions: Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.

Original languageEnglish (US)
Article number762
JournalBMC Infectious Diseases
Issue number1
StatePublished - Dec 1 2020
Externally publishedYes


  • Clostridioides difficile
  • Medicare
  • Social determinants of health
  • Socioeconomic disadvantage

ASJC Scopus subject areas

  • Infectious Diseases


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