Avoiding Double-Trouble Hospitalizations

Almost nothing drives up medical expenses like repeated hospital stays.  So at a time when the nation is struggling to contain runaway medical costs, a study deserves particularly close attention when it identifies key reasons for re-hospitalization of those suffering from pneumonia, a disease afflicting millions every year in the United States. Such a study—recently completed by scholars at the University of Pittsburgh and the University of Texas Southwestern Medical Center—highlights marital status as a prime predictor of re-hospitalization for this illness. It would appear that patients with a living spouse can often stay at home when the same set of symptoms puts spouseless peers back in the hospital.

The authors of the new study justify their inquiry as a much-needed investigation given the scope of the public health problems created by pneumonia. Explaining why “pneumonia remains a significant problem in the United States, both in terms of mortality as well as cost to the healthcare system,” the researchers note that “over a million patients are hospitalized [annually] for pneumonia with costs conservatively estimated at greater than $7 billion in 2010.” These hospitalization costs run so high in large part because “pneumonia is the second most frequent reason for rehospitalization.” 

To identify the antecedents of rehospitalization for pneumonia, the researchers scrutinize data for 45,134 patients ages 65 and older admitted to 150 Veterans Affairs (VA) acute-care hospitals between 2001 and 2007. These data indicate that 13% of the patients were re-admitted within 30 days.

Statistical analysis reveals that some readmissions simply reflect medical need: pneumonia patients with chronic renal disease, for example, and patients with congestive heart failure were, understandably, likely to be readmitted to the hospital.

But while comorbidities such as renal and heart disease explain readmissions in some cases, the researchers conclude that many readmissions reflect sociodemographics more than medical diagnoses. Age, of course, statistically predicts readmission: advancing years render patients more frail, more likely to need readmission to the hospital.

But the researchers also highlight marital status as a predictor of readmission. Compared to peers in an intact marriage, patients without a living spouse were significantly more likely to need readmission (p < 0.01) to the hospital.

Though the researchers do not comment specifically on marital status as a predictor of readmission, that status clearly counts as one of what they call “‘host’ factors” powerfully influencing rehospitalization of patients suffering from pneumonia.” As the researchers survey “the role that ‘host’ factors play in rehospitalization of elderly patients with pneumonia,” they wonder if “readmissions after pneumonia are truly preventable,” given that “there are few potentially modifiable targets to help reduce [such] readmissions.”

But Americans concerned about the nation’s health care might wonder just what the authors mean by “potentially modifiable targets” in this context. In part as the result of public policies subversive of wedlock (such as “no-fault divorce”), Americans have in fact modified their marital behavior dramatically in recent decades, so exposing tens of millions to medical emergencies (such as pneumonia) without the companionship of a spouse.

Perhaps it is time for public health scholars and ordinary citizens alike to recognize that behaviors and laws modified to subvert wedlock might be modified again to restore it. And such marriage-reinforcing modifications would keep a great many thousands suffering from pneumonia—and other illnesses—out of the hospital.

(Victoria L. Tang et al., “Predictors of Rehospitalization after Readmission for Pneumonia in the VA Health Care System,” Journal of Hospital Medicine 9.6 [2014]: 379-83.)