Is social deprivation an independent predictor of outcomes following cardiac surgery? An analysis of 240 221 patients from a national registry

Abstract

ObjectivesSocial deprivation impacts on healthcare outcomes but is not included in the majority of cardiac surgery risk prediction models. The objective was to investigate geographical variations in social deprivation of patients undergoing cardiac surgery and identify whether social deprivation is an independent predictor of outcomes.MethodsNational Adult Cardiac Surgery Audit data for coronary artery bypass graft (CABG), or valve surgery performed in England between April 2003 and March 2013, were analysed. Base hospitals in England were divided into geographical regions. Social deprivation was measured by quintile groups of the index of multiple deprivation (IMD) score with the first quintile group (Q1) being the least, and the last quintile group (Q5) the most deprived group. In-hospital mortality and midterm survival were analysed using mixed effects logistic, and stratified Cox proportional hazards regression models respectively.Results240 221 operations were analysed. There was substantial regional variation in social deprivation with the proportion of patients in IMD Q5 ranging from 34.5% in the North East to 6.5% in the East of England. Following adjustment for preoperative risk factors, patients undergoing all cardiac surgery in IMD Q5 were found to have an increased risk of in-hospital mortality relative to IMD Q1 (OR=1.13; 95%CI 1.03 to 1.24), as were patients undergoing isolated CABG (OR=1.19; 95%CI 1.03 to 1.37). For midterm survival, patients in IMD Q5 had an increased hazard in all groups (HRs ranged between 1.10 (valve+CABG) and 1.26 (isolated CABG)). For isolated CABG, the median postoperative length of stay was 6 and 7 days, respectively, for IMD Q1–Q4 and Q5.ConclusionsSignificant regional variation exists in the social deprivation of patients undergoing cardiac surgery in England. Social deprivation is associated with an increased risk of in-hospital mortality and reduced midterm survival. These findings have implications for health service provision, risk prediction models and analyses of surgical outcomes.

Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit

“…In Europe, data from the EUROASPIRE III survey of 13 935 patients showed older, female patients who did not have coronary artery bypass graft (CABG) surgery and those who smoked were less likely to attend . Consistent with the above findings regarding the centrality of financial/socioeconomic factors, numerous studies have also demonstrated social deprivation (eg, income, employment, and education) as a key factor associated with both low CR utilization and higher mortality …”

“…Variables were chosen for the multivariate analysis based on existing evidence indicating an association with initiation. [6][7][8][9][10][11][12] Independent variables were age, sex, ethnicity, marital status, IMD quintile, employment status, comorbidity count, prior cardiac event, diagnosis of diabetes mellitus, anxiety and depressive symptoms, risk factors, and referral indication. To take account of the nested nature of the data (ie, patients treated within CR centers), the Huber-White-sandwich estimator robust standard errors method was used.…”

“…A multivariate logistic regression was computed to assess factors associated with CR initiation. Variables were chosen for the multivariate analysis based on existing evidence indicating an association with initiation . Independent variables were age, sex, ethnicity, marital status, IMD quintile, employment status, comorbidity count, prior cardiac event, diagnosis of diabetes mellitus, anxiety and depressive symptoms, risk factors, and referral indication.…”

“…9 Consistent with the above findings regarding the centrality of financial/socioeconomic factors, numerous studies have also demonstrated social deprivation (eg, income, employment, and education) as a key factor associated with both low CR utilization and higher mortality. [10][11][12] To date, research on the determinants of CR initiation in English cohorts has been limited, and stems only from small nonrepresentative samples. [13][14][15][16] A more thorough investigation is required to identify country-specific influencing factors that could inform targeted interventions to increase CR utilization.…”

Impact of social deprivation on the outcome of major head and neck cancer surgery in England: A national analysis

“…17 Using smoking as a surrogate for health behaviors in general, while overall epidemiological data are reassuring, there is a clear incongruity between the highest and lowest deprivation groups and this alone could cause differences in incidence and outcomes for HNC. 20,22,23 The aforementioned associations between socioeconomic status, surgical outcomes, risks factors for HNC, and previous work suggest that a relationship may indeed exist, 23,24 and in turn, there may be a notable health gradient outcome when applied to HNC also. 10 This can be significant, encompassing parameters such as Union Internationale Contre le Cancer (UICC) tumor stage, 19 length of hospital stay, 20 number of postoperative complications, 20,21 and overall survival (OS).…”