Does where you live matter? Rurality and 30-day hospital readmission among people with HIV

OBJECTIVE: We examined whether rural residence would compound existing challenges in continuity of HIV care and post discharge follow-up among people with HIV (PWH), leading to higher odds of 30-day hospital readmission compared to urban residence. METHODS: We used data from the Comparative Outcomes and Service Utilization Trends (COAST) study to identify hospitalizations between April 2001 and March 2020. COAST includes virtually all known PWH in British Columbia. Readmissions were defined as hospitalizations occurring within 30 days of discharge. Rural, small urban, and large urban areas were defined using census-derived statistical area classification groups. We used logistic regression models with generalized estimating equations to examine the association between rurality and readmission. RESULTS: Among 7159 PWH included in our analyses, 82.3% (n = 5893) resided in large urban areas,11.8% (n = 848) in small urban areas and 5.9% (n = 418) in rural areas. Living in a small urban area was associated with lower odds of readmission compared with large urban areas [adjusted odds ratio (aOR) = 0.83; 95% confidence interval (CI): 0.72-0.95]. No significant difference in the odds of readmission was observed between large urban and rural areas (aOR = 1.02; 95% CI: 0.86-1.22). CONCLUSION: Small urban residence was associated with lower odds of 30-day hospital readmission among PWH compared with large urban residence, whereas rural residence was not. Further research is needed to identify the healthcare and social factors underlying these geographic differences.