Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years

Pagano, Domenico; Freemantle, Nick; Bridgewater, Ben; Howell, Neil; Ray, Daniel; Jackson, Mark; Fabri, Brian M.; Au, John; Keenan, Daniel; Kirkup, Benjamin; Keogh, Bruce

doi:10.1136/bmj.b902

Cited by 53 publications

(43 citation statements)

References 25 publications

(30 reference statements)

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“…Thus, a recent study from North West England found that social deprivation was an independent correlate of midterm mortality in patients undergoing coronary artery bypass surgery. 13 In our study, patients on the CMUC were younger and had more comorbidities at baseline, suggesting a negative health impact of social deprivation.…”

Section: Discussionmentioning

confidence: 89%

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Danchin

Neumann

Tuppin

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background-The type of medical coverage in patients with acute myocardial infarction (AMI) may affect their treatment and outcome. Methods and Results-We used the reimbursement database from the French National Health Insurance to determine the impact of full medical coverage (Couverture Médicale Universelle Complémentaire, CMUC), a free supplemental insurance for low-income earners Ͻ60 years of age, on treatment and outcomes of patients with AMI. The population comprised consecutive patients Ͻ60 years of age hospitalized for AMI from January to June 2006 in France. Of 4939 patients with AMI aged Ͻ60 years, 587 (12%) were on the CMUC. CMUC patients were younger, with more prior cardiovascular and comorbid conditions. CMUC and non-CMUC patients were admitted to the same types of institutions, including academic hospitals and private clinics. The use of cardiac catheterization and coronary interventions was similar (adjusted relative risk, 0.97; 95% confidence interval, 0.91-1.05; Pϭ0.45). In-hospital mortality was also comparable (3.1% versus 2.8%, Pϭ0.69). There was no difference in early use of secondary prevention medications after multivariate adjustment. At 30 months, survival and acute coronary syndrome-free survival were lower in CMUC patients (trend, not significant after adjustment). Long-term adherence to statin therapy was lower in CMUC patients (64% versus 77%; adjusted relative risk, 0.82; 95% confidence interval, 0.73-0.92). Conclusions-Free full coverage for socially deprived people levels inequalities in the acute and midterm treatment of AMI patients. However, full reimbursement per se is not sufficient to ensure optimal patient adherence to secondary prevention medications and may not be enough to prevent an excess of long-term events. (Circ Cardiovasc Qual Outcomes. 2011;4:619-625.)

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Section: Discussionmentioning

confidence: 89%

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Danchin

Neumann

Tuppin

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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“…1 The relationship between socioeconomic status and various components of health is well established. [2][3][4] Research has also highlighted that social deprivation can affect patterns of injury and outcome after trauma. 5,6 There is a strong relationship between social deprivation and the incidence of injury, and evidence suggests that the disadvantaged are less likely to survive.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 There is a strong relationship between social deprivation and the incidence of injury, and evidence suggests that the disadvantaged are less likely to survive. [2][3][4][5][6] Higher crime rates and alcoholism associated with deprived areas may result in increased incidence of trauma. Previous research has suggested that deprivation may be a risk factor for poorer outcomes due to the association with smoking, extremes of body mass index or diabetes, financial hardship and homelessness.…”

Section: Introductionmentioning

confidence: 99%

“…Previous research has suggested that deprivation may be a risk factor for poorer outcomes due to the association with smoking, extremes of body mass index or diabetes, financial hardship and homelessness. 2,3 The interaction between outcomes following blunt chest trauma and socioeconomic status has received limited attention in trauma research. Mortality rates in blunt chest wall trauma have been reported to 1 range between 5.7% 7 and 18.7%.…”

Section: Introductionmentioning

confidence: 99%

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Social deprivation and adult blunt chest trauma: A retrospective study

Battle

Hutchings

Bouamra

et al. 2014

Journal of the Intensive Care Society

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Introduction:The relationship between socioeconomic status and various components of health is well established. Research has also highlighted that social deprivation can affect patterns of injury and outcome after trauma. The interaction between outcomes following blunt chest trauma and socioeconomic status has received limited attention in trauma research. The aim of this study was to investigate the relationship between socioeconomic factors, mechanisms of injury and outcomes following blunt chest trauma using deprivation measures calculated on the basis of domicile postcodes. Methods: A retrospective study design was used in order to examine the medical notes of all blunt chest wall trauma patients who presented to the ED of a large regional trauma centre in South West Wales in 2012 and 2013. Baseline characteristics were presented as median and interquartile range or numbers and percentages. Differences between the baseline characteristics were analysed using Mann-Whitney U test and Fisher's exact test. Odds ratios and 95% confidence intervals were presented from the univariable analysis. Multivariable logistic regression analysis was used to identify significant predictors for the development of complications. Results: Patients in the 'more deprived' group were more likely to be the victims of assault (p < 0.001) and were more likely to have an unplanned re-attendance at the Emergency Department than the patients in the 'less deprived' group (p < 0.001). On multivariable analysis, social deprivation was not a risk factor for the development of complications, but it was a significant risk factor for prolonged length of stay (p < 0.05). Conclusions: This is the first study in which social deprivation has been investigated as a risk factor for complications following isolated blunt chest wall trauma. Residing in a 'more deprived' area in South West Wales is not associated with the development of complications following isolated blunt chest wall trauma.

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“…Talán ennek is köszönhetően -noha a szívsebészeti betegek között szintén magas a társbe-tegségek előfordulási aránya, és ők is hasonlóan nagy kockázatú műtéteken esnek át -az ő esetükben a halá-lozási arány mindössze 2% [6,7,8].…”

Section: A Műtét Végeztévelunclassified

Improving patient safety in perioperative care for major surgeries

Horváth

Reusz²,

Gál

et al. 2012

Orvosi Hetilap

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A Helsinki Deklaráció egy olyan dokumentum, amelyet közösen hozott létre a két legjelentősebb európai aneszteziológustársaság: a European Board of Anaesthesiology (EBA) és a European Society of Anaesthesiology (ESA). A kezdeményezést 2010 júniusában bocsátották útjára, és egy olyan európai konszenzust jelent, amelyben foglaltak használata igazoltan javítja a betegek biztonságát és a minőségi perioperatív ellátást. A program elemei közül a szerzők négy területet emelnek ki, amelyek kis ráfordítással bevezethetők és egyértelműen előnyösek: a műtéti ellenőrző lista, a műtétekhez társuló fertőzések megelőzése, a célorientált folyadékterápia és a perioperatív táplálás. Az irodalmi áttekintés hangsúlyozza, hogy a jól szervezett perioperatív ellátás kulcsfontosságú szerepet tölt be a betegbiztonság javításában. Orv. Hetil., 2012, 153, 1447-1455. Kulcsszavak: betegbiztonság, perioperatív ellátás, műtéti ellenőrző listaImproving patient safety in perioperative care for major surgeriesThe Helsinki Declaration was created and signed by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was initiated in June 2010, and it implies a European consensus on those medical practices which improve patient safety and provide higher quality perioperative care. Authors focus on four elements of this initiative, which can be easily implemented, and provide almost instant benefi t: use of preoperative checklist, prevention of perioperative infections, goal-directed fl uid therapy and perioperative nutrition. The literature review emphasizes that well organized perioperative care plays the most important role in improving patient safety. Orv. Hetil., 2012, 153, 1447-1455. A jelenlegi becslések szerint világszerte 250 millió nagy sebészeti beavatkozás történik évente, az ezeket követő komplikációk pedig a morbiditási és mortalitási statisztikák "előkelő" helyén állnak: 1%-os kórházi mortalitást feltételezve ez évi 2,5 millió halálesetet jelent világ-szerte, míg a műtétek kapcsán fellépő komplikációk aránya ennek ötszörösére tehető [1]. Az Egyesült Király-ságban végzett tanulmányok alapján egy könnyen be-

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Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years

Cited by 53 publications

References 25 publications

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Social deprivation and adult blunt chest trauma: A retrospective study

Improving patient safety in perioperative care for major surgeries

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