Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period

Armenia, Sarah J.; Pentakota, Sri Ram; Merchant, Aziz M.

doi:10.1016/j.jss.2017.01.015

Cited by 45 publications

(40 citation statements)

References 33 publications

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“…[2][3][4][5][6] These analyses are inherently limited in their ability to define a true relationship between health disparities and outcomes. Other studies have used components such as household income [7][8][9] and employment status [10,11] to estimate overall SES and evaluate their relationship with outcomes. The most comprehensive studies to date have used multiple indicators from census data to determine a patient's SES and its impact on failure to rescue after cancer surgery [12], preoperative quality of life [13], and mortality after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Charles

Mehaffey

Hawkins

et al. 2019

The Annals of Thoracic Surgery

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Background: The effects of socioeconomic factors other than insurance status and race on outcomes following cardiac surgery are not well understood. We hypothesized that the Distressed Communities Index (DCI), a comprehensive socioeconomic ranking by zip code, would predict operative mortality following coronary artery bypass grafting (CABG). Methods: All patients who underwent isolated CABG (2010-2017) in the Virginia Cardiac Services Quality Initiative database were analyzed. The DCI accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies, with scores ranging from 0 (no distress) to 100 (severe distress). Patients were stratified by DCI quartiles (I: 0-24.9, II: 25-49.9, III: 50-74.9, IV: 75-100) and compared. Hierarchical linear regression modeled the association between DCI and mortality. Results: A total of 19,756 CABG patients were analyzed, with mean PROM of 2.0±3.5%. Higher DCI scores were associated with increasing PROM. Overall operative mortality was 2.1% [n=424] and increased with increasing DCI quartile (I: 1.6% [95], II: 2.1% [77], III: 2.4% [114],

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Section: Introductionmentioning

confidence: 99%

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Charles

Mehaffey

Hawkins

et al. 2019

The Annals of Thoracic Surgery

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“…Similarly, low SES has been tied to worse outcomes in cardiovascular disease and even hospital selection in European countries with universal healthcare 5 6. Socioeconomic disparities have important patient level effects, which have been demonstrated using surrogates including race, insurance status and income 7–10. However, community level factors are critical to understand when assessing the impact of SES on clinical outcomes 11 12.…”

Section: Introductionmentioning

confidence: 99%

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

et al. 2019

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BackgroundSocioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation.MethodsAll patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0–100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation.ResultsA total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted riskConclusionIncreasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.

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“…Regarding the risk of in-hospital death, many studies have suggested that lower income is associated with a higher risk of in-hospital mortality. 26,27 Present study findings show that both male and female older DM patients with higher incomes had significantly reduced inpatient death. However, the effect of income level on in-hospital death may be multifactorial.…”

Section: Results Of the Survival Analysis For Hospitalization And In-mentioning

confidence: 53%

Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan

Jiang

Babazono

Fujita

2020

Population Health Management

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The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013-2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium-and high-income males, respectively,

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Socioeconomic factors and mortality in emergency general surgery: trends over a 20-year period

Cited by 45 publications

References 33 publications

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery

Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis

Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan

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