Clinical InvestigationOutcomes, Health Policy, and Managed CareArea socioeconomic status and mortality after coronary artery bypass graft surgery: The role of hospital volume
Section snippets
Setting and study population
Data were collected as part of the CCMRP.14, 15 This registry, based on the Society of Thoracic Surgeons Template, contains information collected from 75 California hospitals on 20 864 participants who underwent isolated CABG (ie, concomitant valve or aortic surgery was excluded) between January 1, 1999, and December 31, 2000. Trained abstractors performed a comprehensive and detailed clinical data extraction. Accuracy of the CCMRP data was assured through an independent, external audit of 1006
Results
Of the 18 961 patients in our sample, 501 (2.6%) died inhospital after their CABG surgery. Contrary to our hypothesis, in unadjusted analyses, SES was not associated with greater CABG mortality. Inhospital mortality was 2.66% (n = 167) among individuals residing in low-SES areas, 2.57% (n = 163) among individuals residing in medium-SES areas, and 2.70% (n = 171) among individuals residing in high-SES areas (P = .89).
Discussion
Improving socioeconomic disparities in cardiovascular health requires identification of mechanisms potentially amenable to improvement. We had hypothesized that one of these mechanisms could be hospital selection. We expected that individuals of low SES would have greater mortality after CABG, mediated through both a poorer clinical risk factor profile and reduced access to CABG at hospitals presumed to have higher quality. We confirmed that individuals residing in low-SES areas did indeed have
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2022, Annals of Thoracic SurgeryCitation Excerpt :Numerous studies using a variety of social risk indicators have consistently demonstrated the adverse effects of lower SDS/SES status. These include decreased overall access to healthcare; presentation at later and more advanced disease stages52,53; use of lower-quality or underresourced hospitals and less capable physicians and surgeons, even when higher quality providers are geographically closer52,54-79; reduced or delayed access to specialized, advanced, or optimal services and treatments55,80-88; and worse short and long-term health outcomes, including mortality, morbidity, and readmissions, across a broad range of conditions and procedures.35,36,48,54,57,58,66-72,81,82,84-106 Arguments for and against the inclusion of social risk factors in healthcare risk models have been summarized in numerous recent reports.24-34,107
Social Risk Factors in Society of Thoracic Surgeons Risk Models. Part 2: Empirical Studies in Cardiac Surgery; Risk Model Recommendations
2022, Annals of Thoracic SurgeryCitation Excerpt :Patients from counties with the lowest housing values had markedly increased risk of death at 36 months postoperatively (hazard ratio [HR], 2.46; 95% CI, 1.26-4.78). In an analysis of data from the California CABG Mortality Reporting Program, Kim and colleagues6 studied patients who underwent CABG in 1999 through 2000. Overall, mortality by volume was 3.42% in hospitals that performed <240 CABG procedures annually, 2.60% in medium-volume hospitals, and 1.92% in hospitals that performed ≥490 CABG procedures annually.
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This study was supported by a grant from the Robert Wood Johnson Health and Society Scholars Program, the American Diabetes Association, and NIDDK K23-DK071552.