Graduation Date

Summer 8-13-2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Dr. David Palm

Second Advisor

Dr. Fernando Wilson

Third Advisor

Dr. Hyo Jung Tak

Fourth Advisor

Dr. Nizar Wehbi

MeSH Headings

30 Day Readmission, Cardiac Arrhythmia, National Readmission Database, Diabetes, Foreign born, Health Service Utilization, Health Expenditure, Hypertension, High Cholesterol Levels


Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic syndrome is associated with increased healthcare use, increased post-operative complications, prolonged hospital stays, and healthcare-related costs. Metabolic syndrome is becoming a major public health challenge.

Cardiac Arrhythmia (CA) is a group of conditions where the heart beats either too fast or too slow or irregularly. Atrial fibrillation (AF) is the most common arrhythmia in the U.S. and is projected to increase to 15.9 million by 2050. Diabetes increases the risk of AF by 40% as compared to non-diabetic patients. Diabetes contributes to multiple types of CA and their coexistence pose unique challenges for clinical treatment. CA are not serious acutely, but prolonged episodes increase the likelihood of stroke, heart attack and cardiac arrest. Estimating factors linked with increased hospital unplanned readmission would help in planning by healthcare professionals and policy makers.

Estimating the healthcare utilization and expenditures for CA and diabetes would provide crucial information for public health intervention priorities, and resource planning. Therefore, this dissertation examined the predictors and risk factors associated with readmissions in CA, quantified the economic burden in U.S. adults with diabetes and dependent on (i) nativity status, and (ii) new-onset hypertension & hypercholesterolemia. For this I used National Readmission Database to estimate the cost and risk factors for 30-day unplanned readmissions in patients with CA. I also used Medical Expenditure Panel Survey from 2016 to 2018 data to estimate the health service utilization and expenditures related to nativity status and onset of new chronic conditions of hypertension and hypercholesterolemia in diabetic adults.