Effect of Neighborhood Socioeconomic Factors on Readmissions and Mortality After Coronary Artery Bypass Grafting
| Autor: | Christopher M. Sciortino, Yisi Wang, Danny Chu, Floyd Thoma, Ayesha Shah, Thomas G. Gleason, Arman Kilic, Amber Okoye, Garrett N. Coyan |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Patient zip code medicine.medical_specialty Bypass grafting Psychological intervention 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Residence Characteristics Humans Medicine Social determinants of health Coronary Artery Bypass Socioeconomic status Aged business.industry Middle Aged medicine.anatomical_structure Social Class 030228 respiratory system Quartile Emergency medicine Income Household income Female Surgery Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The Annals of Thoracic Surgery. 111:561-567 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.05.102 |
| Popis: | Social determinants of health, including neighborhood socioeconomic status (NSES), are increasingly being associated with disparate outcomes in those undergoing cardiac procedures. The objective of this study was to determine the effect of NSES on outcomes after coronary artery bypass grafting (CABG).Adults undergoing isolated CABG between July 2011 and December 2017 were retrospectively reviewed. Neighborhood median household income (NMI) and neighborhood high school graduation rate (NHS) were obtained by individual patient ZIP code from the American FactFinder Database. Primary outcome was 5-year all-cause mortality stratified by NMI quartile. Secondary end points included mortality risk by NHS, freedom and frequency of readmission, and mortality and readmission predictors.During the study period, 5243 patients underwent CABG. Increasing NMI quartile was associated with increasing age, male sex, white race, decreased diabetes prevalence, decreased active smoker status, and decreased lung disease (all P.05). Although no difference in 30-day mortality was observed, lower NMI quartiles were associated with increased longitudinal mortality through 5 years (log-rank P.01). Lower NMI quartile was associated with increased blood transfusions and sternal wound infections. Multivariable modeling demonstrated multiple complex associations between socioeconomic status variables (race, sex, age, NMI, and NHS) for mortality and readmission.NSES affects longer-term outcomes after CABG. Patient-focused NSES interventions and incorporation of NSES variables into prediction models may improve prediction and outcomes after CABG. |
| Databáze: | OpenAIRE |
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