The Association of Socio-Economic Factors with Outcomes for Coronary Artery Bypass Surgery.

Overview

abstract

BACKGROUND: Numerous studies have identified the associations of socio-economic factors with outcomes of cardiac procedures. The majority have focused on easily measured factors like sex, race, and insurance status, or on socio-economic characteristics of patients' 5-digit zip codes. The impact of more granular census-derived socio-economic information on outcomes has rarely been studied. METHODS: The independent impact of the Area Deprivation Index (ADI) on short-term mortality and readmissions was tested on patients undergoing isolated coronary artery bypass graft (CABG) surgery in New York by using it in logistic regression models in conjunction with patient risk factors and typical disparities measures (race, ethnicity, payer). Changes in hospitals' risk-adjusted outcomes and outlier status with the addition of socio-economic measures were also tested. RESULTS: After adjusting for numerous patient characteristics, patients in the fourth and fifth highest ADI quintiles (most deprived) were more likely to experience in-hospital/30-day mortality following CABG surgery (AOR = 1.54 (1.08, 2.20) and AOR = 1.50 (1.02, 2.21)), respectively. ADI was not associated with readmissions, but African Americans (AOR = 1.49 (1.18, 1.87)), Hispanics (AOR = 1.33 (1.06, 1.65)) and Medicaid patients (AOR = 1.34 (1.09, 1.64)) were more likely to be readmitted. CONCLUSIONS: Patients with high ADIs are more likely to experience short-term mortality following CABG surgery. African Americans, Hispanics and Medicaid patients are more likely to experience 30-day readmissions. This information should be taken into account when monitoring patients to reduce adverse events following surgery, and more studies related to ADI are needed to fully understand its implications.