Neighborhood socioeconomic status is associated with differences in operative management and long-term survival after coronary artery bypass grafting

Patrick, William L.; Bojko, Markian; Han, Jason J.; Kelly, John; Iyengar, Amit; Helmers, Mark R.; Smood, Benjamin; McCarthy, Fenton H.; Williams, Matthew Leighton

doi:10.1016/j.jtcvs.2020.08.024

Cited by 20 publications

(14 citation statements)

References 22 publications

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“…[6][7][8][9] Within cardiac surgery, lower socioeconomic status (SES) has been associated with greater mortality and morbidity after valve surgery and coronary artery bypass grafting (CABG). 10,11 In patients with TAA, it has been observed that lower SES and lack of health insurance is associated with greater acuity of presentation and higher mortality after aortic events (dissection and rupture). 12 However, it is unknown how SES affects the follow-up care and progression of TAAs prior to this.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Shang

Weininger

Mori

et al. 2021

Preprint

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Background: Thoracic aortic aneurysm is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status and surveillance practices in patients with ascending aortic aneurysms. Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013-2016 with ascending aortic aneurysm ≥4cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing socioeconomic status at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death prior to follow up with a cardiovascular specialist. Results: Lower socioeconomic status was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest socioeconomic status had lower hazard of follow-up with a cardiologist or cardiac surgeon prior to death (HR 0.46 [0.34, 0.62], p<0.001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs 23-38%, p<0.001). Conclusion: Patients with lower socioeconomic status receive less timely follow-up imaging and specialist referral for thoracic aortic aneurysms, resulting in surgical intervention only when alarming symptoms are already present.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Shang

Weininger

Mori

et al. 2021

Preprint

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confidence: 99%

“…A recent article by Patrick and colleagues 1 implies that the answer to the question, Are cardiac surgeons treating patients of lower socioeconomic status differently? is: Yes.…”

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confidence: 99%

Commentary: Are cardiac surgeons treating patients of lower socioeconomic status differently?

Lee

Weintraub

2022

The Journal of Thoracic and Cardiovascular Surgery

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A recent article by Patrick and colleagues 1 implies that the answer to the question, Are cardiac surgeons treating patients of lower socioeconomic status differently? is: Yes.Patrick and colleagues 1 elegantly develop a model defining lower socioeconomic status (SES) using 17 US Census Bureau variables in patients undergoing coronary artery bypass grafting at the University of Pennsylvania and define status at block group level. The Penn team divided the patients into neighborhood SES quartiles, demonstrating that patients in lower socioeconomic quartiles have worse short-term and long-term outcomes. There is also an inverse association to the use of arterial grafts, raising the question of a relationship between long-term outcomes and lack of multiarterial grafting.As a heart surgeon and cardiologist who are also scientists, this concerns us. The implication is that as providers, we may implicitly or explicitly be biased against offering optimal treatment to this group. Although this may be true, it makes all of us who took and believe that we follow the Hippocratic Oath uncomfortable. Anything that makes us uncomfortable is certainly worth consideration.Unfortunately, we remain unconvinced for many reasons, despite this elaborate analysis. First, every retrospective study is subject to selection bias that cannot ever be fully controlled for. Here, more than half the quartile 1 patients were diabetic compared with less than one-third in quartile 4 before adjustment. Myriad other factors, such as lung disease, peripheral vascular disease, dialysis, kidney disease, and heart failure are higher in the lower 2 quartiles. Many

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“…Patrick and colleagues 1 present an analysis of socioeconomic status (SES) in patients undergoing coronary artery bypass grafting in this month's Journal. The authors employ the validated Area Deprivation Index (ADI), which is a block-level measure of SES based on 17 indicators from the US Census data.…”

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confidence: 99%

Commentary: Regardless of how you divide it, socioeconomic status determines outcomes

Mehaffey

Hawkins

2022

The Journal of Thoracic and Cardiovascular Surgery

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Neighborhood socioeconomic status is associated with differences in operative management and long-term survival after coronary artery bypass grafting

Cited by 20 publications

References 22 publications

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Commentary: Are cardiac surgeons treating patients of lower socioeconomic status differently?

Commentary: Regardless of how you divide it, socioeconomic status determines outcomes

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