The Association of Socioeconomic Factors With Percutaneous Coronary Intervention Outcomes.

Autor: Hannan EL; Cardiac Services Program, University at Albany, State University of New York, Albany, New York, USA. Electronic address: edward.hannan@health.ny.gov., Wu Y; Cardiac Services Program, University at Albany, State University of New York, Albany, New York, USA., Cozzens K; Cardiac Services Program, University at Albany, State University of New York, Albany, New York, USA., Friedrich M; Office of Quality and Patient Safety, New York State Department of Health, Albany, New York, USA., Walford G; Department of Cardiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA., Ling FSK; Department of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Venditti FJ; Department of Administration, Albany Medical Center, Albany, New York, USA., Jacobs AK; Department of Cardiology, Boston Medical Center, Boston, Massachusetts, USA., Tamis-Holland J; Department of Cardiology, Mount Sinai Saint Luke's Hospital, New York, New York, USA., Berger PB; Unaffiliated, Carmel, New York, USA., King SB 3rd; Department of Cardiology, Emory Health System, Atlanta, Georgia, USA.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2022 Jan; Vol. 38 (1), pp. 13-22. Date of Electronic Publication: 2021 Oct 02.
DOI: 10.1016/j.cjca.2021.09.029
Abstrakt: Background: Numerous studies have identified the association of socioeconomic factors with outcomes of cardiac surgical procedures. Most have focused on easily measured demographic factors or on socioeconomic characteristics of patients' 5-digit zip codes. The impact of socioeconomic information that is derived from smaller geographic regions has rarely been studied.
Methods: The association of the Area Deprivation Index (ADI) with short-term mortality and readmissions was tested for patients undergoing percutaneous coronary intervention (PCI) in New York while adjusting for numerous patient risk factors, including race, ethnicity, and payer. Changes in hospitals' risk-adjusted outcomes and outlier status with the addition of socioeconomic factors were examined.
Results: After adjustment, patients in the 2 most deprived ADI quintiles were more likely to experience in-hospital and 30-day mortality after PCI (adjusted odds ratios [95% confidence intervals] 1.39 [1.18-1.65] and 1.24 [1.03-1.49], respectively), than patients in the first quintile (least deprived). Also, patients in the second and fifth ADI quintiles had higher 30-day readmissions rates than patients in the first quintile (1.12 [1.01-1.25] and 1.17 [1.04-1.32], respectively). Medicare patients had higher mortality and readmission rates, Hispanics had lower mortality, and Medicaid patients had higher readmission rates.
Conclusions: Patients with the most deprived ADIs are more likely to experience short-term mortality and readmissions after PCI. Ethnicity and payer are significantly associated with adverse outcomes even after adjusting for ADI. This information should be considered when identifying patients who are at the highest risk for adverse events after PCI and when risk-adjusting hospital outcomes and assessing quality of care.
(Copyright © 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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