Neighborhood socioeconomic status associated with poorer patient outcomes after heart surgery
According to a study presented at the 58and Annual meeting of the Society of Thoracic Surgeons.
We undertook this work in collaboration with the Society of Thoracic Surgeons to better understand the impact of socioeconomic status on mitral valve surgery in the United States. The STS Adult Cardiac Surgery Database has been linked to a very robust composite metric that assesses average SES across census block groups and has been shown to be related to mortality and death rate. success of a repair, independent of all other demographics or at the hospital and surgeon level. features we have.”
Amit Iyengar, MD, MSE, University of Pennsylvania, Philadelphia
Using data from the STS Adult Cardiac Surgery Database, Dr. Iyengar and colleagues identified 46,831 adult patients who underwent first-time isolated mitral valve repair or replacement for degenerative mitral disease. from 2012 to 2018. Socioeconomic status was calculated using the 2018 Area Deprivation Index (ADI), a geography-derived measure used to assess average income, education, employment, and quality housing for a given region. For this research, the group queried the ADI at the level of a single city block or rural equivalent.
“We confirmed the effect of ADI by examining it more closely in smaller primed subsets,” Dr. Iyengar said. “We did this thoughtfully, trying to shed light on the mechanisms by which socioeconomic status would affect outcomes.”
The researchers determined that low SES patients -; who more often received health care through government payer programs such as Medicare and Medicaid (63% vs. 49%) -; had more urgent/emergent surgery (21% versus 13%), with minimally invasive approaches used less often (24% versus 39%).
“Neighborhood SES is associated with different valve pathologies and presentations,” Dr. Iyengar said. “Clinically, the extremes of SES represent two different patient populations; elective degenerative disease (high SES) and the more urgent nondegenerative disease (low SES).”
Additionally, and importantly, low SES was associated with a lower repair rate (65.3% versus 82.8%). Mitral valve repair has been widely considered the optimal surgical procedure for treating mitral valve disease and can help minimize complications that can occur during replacement, including the risk of blood clots with mechanical valves. In fact, low SES patients not only had a higher complication rate (48% versus 40%), but also a higher 30-day mortality rate (2.9% versus 1.3%).
“The data is very revealing and shows several important findings such as low SES patients have larger incisions, fewer repairs, and poorer outcomes in terms of complications and mortality,” said T. Sloane Guy, MD, MBA, from Thomas Jefferson University in Philadelphia. , Pennsylvania, who was not directly involved in this research. “There have been many papers lately suggesting that certain groups of patients based on gender, race, or socioeconomic status have worse outcomes. The usual conclusion is that these patients get worse medical care. But the question is more complicated, and I think most of us live by the principle that we treat all patients equally, regardless of their characteristics.”
This research also showed that high SES patients tend to travel farther for surgery (33 versus 17 miles) and have operations from higher volume surgeons (62±69 versus 31±46 cases /year).
Dr Guy explained that access to care and the ability to visit a high-volume mitral valve specialist has “clearly emerged as a discriminator” that negatively impacts people living in deprived neighborhoods on the socio-economic level. “Presumably they have limited resources and options compared to those living in other neighborhoods,” he said.
The researchers acknowledge that, moving forward, more work is needed to determine how best to address these types of treatment disparities. Dr Guy shared that efforts should focus on improving patient access to quality health insurance, care and information.