Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease

Ultee, Klaas H.J.; Gonçalves, Frederico Bastos; Hoeks, Sanne E.; Rouwet, Ellen V.; Boersma, Eric; Stolker, Robert Jan; Verhagen, Hence J.M.

doi:10.1016/j.ejvs.2015.07.006

Cited by 49 publications

(37 citation statements)

References 43 publications

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“…The association between low SEP and rAAA as index diagnosis has previously been described in a limited number of studies,28 but unlike our study, these only included patients who underwent repair for their rAAA,28 which could lead to an underestimation of the true association between low SEP and presentation of disease.…”

Section: Discussionmentioning

confidence: 86%

Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome

Zommorodi

Leander

Roy³

et al. 2018

J Epidemiol Community Health

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Section: Discussionmentioning

confidence: 86%

Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome

Zommorodi

Leander

Roy³

et al. 2018

J Epidemiol Community Health

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“…For patients with PAD, previous studies have suggested an association between poverty, measured in a variety of ways, and severity of presentation at the time of surgery, increased postoperative mortality and major amputation 13 24. These differences have been attributed to where patients seek care and adherence to guideline-recommended follow-up care.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after peripheral artery disease intervention among Medicare–Medicaid dual-eligible patients compared with the general medicare population in the Vascular Quality Initiative registry

Austin

Chakraborti

Columbo

et al. 2019

BMJ Surg Interv Health Technologies

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ObjectiveTo determine whether patients from the Vascular Quality Initiative (VQI) registry who are Medicare–Medicaid dual-eligible have outcomes after surgical intervention with medical devices such as stents for peripheral artery disease comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries from 2010 to 2015 who underwent peripheral vascular intervention as determined by the VQI. We performed propensity matching between the dual-eligible and non-dual-eligible cohorts. Postintervention use, including imaging, amputation and death, was determined using Medicare claims data.ResultsRates of major amputation were higher among dual-eligible patients (13.0% vs 10.5%, p<0.001), while time to amputation by disease severity was similar (p=0.443). For patients with more advanced disease (critical limb ischaemia (CLI) vs claudication), dual-eligible patients have significantly faster times to any amputation and death (p<0.001). For of postoperative imaging, 48.4% of dual-eligible patients receive at least one postoperative image, while the percentage for non-dual-eligible patients is 47.2% (p=0.187).ConclusionsPatients with mild forms of peripheral artery disease (PAD), such as claudication, demonstrated similar outcomes regardless of dual-eligibility status. However, those with severe PAD, such as CLI, who were also dual-eligible had both inferior overall survival and amputation-free survival. Minimal differences were observed in process-driven aspects of care between dual-eligible and non-dual-eligible patients, including postoperative imaging. These findings indicate that despite receiving similar care, dual-eligible patients with severe PAD have inferior long-term outcomes, suggesting the Medicaid safety net is not timely enough to benefit from long-term outcomes for these patients.

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“…[ 15 ] Procedures are detailed in S1 Table . Since the association between low household income and worse outcome among vascular surgery patients has been established in the previous study,[ 14 ] vascular procedures were excluded. Additional exclusion criteria were surgical interventions performed under local anesthesia, and patients younger than 14 years at the time of the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously demonstrated in a vascular surgery population that SES–quantified by gross household income–implicated significant postoperative survival risks, independent from conventional medical and environmental risk factors. [ 14 ] These findings suggest that SES encompasses a wide variety of risk factors and behaviors that are not adequately captured by conventionally considered risk factors.…”

Section: Introductionmentioning

confidence: 99%

The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare

et al. 2018

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BackgroundThe impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications.MethodsPatients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES–quantified by gross household income–with major 30-day complications and long-term postoperative survival.ResultsA total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01–1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08–2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07–1.48, first income quartile: HR: 3.10, 95% CI: 1.04–9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications.ConclusionsLow SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.

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Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease

Cited by 49 publications

References 43 publications

Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome

Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome

Outcomes after peripheral artery disease intervention among Medicare–Medicaid dual-eligible patients compared with the general medicare population in the Vascular Quality Initiative registry

The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare

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