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Published on: March 27, 2018
Distressed communities are associated with worse outcomes after coronary artery bypass surgery
J Hunter Mehaffey1, Robert B Hawkins1, Eric J Charles1
1Department of Surgery, University of Virginia, Charlottesville, Va.
Insights
Patients from distressed communities face higher risks of death and complications after coronary artery bypass grafting. The Distressed Communities Index effectively identifies these high-risk individuals for improved cardiac surgery outcomes.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Health Economics
Background:
- Socioeconomic status (SES) impacts health outcomes, but traditional metrics like income or insurance status offer limited insights.
- Previous analyses of cardiac surgery complications often overlooked comprehensive SES indicators.
Purpose of the Study:
- To evaluate the Distressed Communities Index (DCI), a composite SES metric, as a predictor of operative mortality following coronary artery bypass grafting (CABG).
Main Methods:
- Utilized data from the National Society of Thoracic Surgeons database (2011-2018) for isolated CABG patients.
- Paired patient clinical data with the DCI, a ZIP code-level index assessing unemployment, education, poverty, income, business growth, and housing vacancies.
- Defined distressed communities as those with a DCI score of 75 or greater.
Main Results:
- The study included 575,900 CABG patients; operative mortality was 2.0% and composite morbidity/mortality was 11.5%.
- Patients from distressed communities (DCI ≥ 75) had higher predicted mortality and composite morbidity/mortality risk.
- The DCI remained a significant predictor of mortality (OR 1.12) and composite morbidity/mortality (OR 1.03) after adjusting for the Society of Thoracic Surgeons risk model.
Conclusions:
- Patients residing in distressed communities experience elevated risks of adverse outcomes and mortality after CABG.
- The DCI serves as a valuable, holistic SES measure for identifying high-risk patients in quality improvement initiatives.
- The DCI should be integrated into risk models and hospital comparison metrics for a more accurate assessment of surgical outcomes.
Objectives:
Although low socioeconomic status has been associated with increased risk of complications after cardiac surgery, analyses have typically focused on insurance status, race, or median income. We sought to determine if the Distressed Communities Index, a composite socioeconomic metric, could predict operative mortality after coronary artery bypass grafting.
Methods:
All patients who underwent isolated coronary artery bypass grafting (2011-2018) in the National Society of Thoracic Surgeons adult cardiac surgery database were analyzed. Clinical data were paired with the Distressed Communities Index, which accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies by ZIP code. Developed by the Economic Innovation Group, Distressed Communities Index scores range from 0 (no distress) to 100 (severe distress). A distressed community was defined as one having a Distressed Communities Index of 75 or greater for univariate analyses.
Results:
Of the 575,900 patients undergoing coronary artery bypass grafting with a Distressed Communities Index score, the median age was 65 years. The operative mortality rate was 2.0%, and the composite morbidity or mortality rate was 11.5%. Distressed communities were associated with increased Society of Thoracic Surgeons predicted risk of mortality (1.97% vs 1.85%, P < .0001) and risk of composite morbidity or mortality (12.8% vs 11.7%, P < .0001). After adjusting for Society of Thoracic Surgeons risk model, the Distressed Communities Index remained significantly associated with mortality (odds ratio, 1.12; P < .0001) and composite morbidity and mortality (odds ratio, 1.03; P = .002).
Conclusions:
Patients from distressed communities are at increased risk for adverse events and death after coronary artery bypass grafting. The Distressed Communities Index is a useful, holistic measure of socioeconomic status that may help identify high-risk patients for quality improvement and should be considered when building risk models or comparing hospitals.
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