Objective: To investigate the relationship between income and hospital length of stay (LOS) and discharge disposition in a Parkinson Disease (PD) cohort admitted to the hospital in the United States (US).

Background: The role of socioeconomic factors in PD hospitalizations is unclear. Yoon et al. found an association between low socioeconomic status and higher mortality in PD (1). Murata et al suggested that low income was associated with longer hospital stays and higher long-term care admissions in dementia (2). We hypothesize that low income is associated with increased hospital LOS and non-home discharge in PD.

Method: This was a cross-sectional study. Data was extracted from the National Inpatient Sample database for the year 2014. PD was defined by the presence of a code for PD, ICD-9 code 332.0. Income was defined by the median household income quartile for the patient’s ZIP code. Outcomes of interest were hospital LOS (days) and discharge disposition (home vs non-home). We used a multivariable negative binomial regression model to study the association between income and LOS and a multivariable logistic regression to study the association between income and discharge disposition. Models were adjusted for age, sex, race, Elixhauser Comorbidity Index (ECI), admission type (elective vs non-elective) and the following hospital factors: bed size, control/ownership (government vs private), region, location/teaching status.

Results: Our cohort included 51,129 individuals; most were males (57%). The median (interquartile range, IQR) age was 78 years old (78-84). Most admissions were non-elective (84%), with a median (IQR) LOS of 4.0 (3-7) days. Only 30% of discharges were home. The third and highest income quartiles were associated with shorter LOS compared to the lowest income quartiles (respectively adjusted incident rate ratio (IRR)=0.97, 95% confidence interval (CI)=0.96;0.99, p-value=0.014; adjusted IRR=0.97, 95% CI=0.95;0.99, p-value=0.005). No significant association between income and discharge disposition were found, after adjusting for covariates.

Conclusion: We found a significant association between higher income and shorter hospital LOS after adjusting for covariates. Additional analyses including potential days saved if IRR were equalized may help clarify the clinical significance of these findings. Future studies should evaluate the role of social interventions in PD hospitalizations.

References: 1.Yoon SY, Shin J, Chang JS, Lee SC, Kim YW. Effects of socioeconomic status on mortality after Parkinson’s disease: A nationwide population-based matched cohort study in Korean populations. Parkinsonism Relat Disord. 2020;80:206-11.
2.Murata F, Babazono A, Fukuda H. Effect of income on length of stay in a hospital or long-term care facility among older adults with dementia in Japan. Int J Geriatr Psychiatry. 2020;35(3):302-11.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-income-and-hospital-length-of-stay-in-parkinson-disease-a-nationwide-cross-sectional-analysis/