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Effect of Socioeconomic Distress on Risk-Adjusted Mortality After Valve Surgery for Infective Endocarditis.
Raymond J Strobel1, Eric J Charles1, J Hunter Mehaffey1
1Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
Seminars in Thoracic and Cardiovascular Surgery
|May 19, 2022
Summary
Socioeconomic status, measured by the Distressed Communities Index (DCI), significantly impacts infective endocarditis outcomes. Higher DCI scores predict increased mortality and resource use in these patients.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Health Services Research
Background:
- Infective endocarditis (IE) is a serious condition affecting diverse populations.
- Socioeconomic status (SES) is a known determinant of health outcomes.
- The Distressed Communities Index (DCI) offers a comprehensive measure of community-level SES.
Purpose of the Study:
- To investigate the association between the DCI and risk-adjusted mortality in patients with IE.
- To determine if SES, as measured by DCI, independently predicts outcomes in IE patients.
Main Methods:
- Analysis of 2,075 IE patients (2001-2017) from a Society of Thoracic Surgeons database.
- Utilized hierarchical logistic regression to model the association between DCI scores and mortality.
- Compared patients in the highest DCI quartile (DCI > 75) to all others.
Main Results:
- High socioeconomic distress (DCI > 75) correlated with increased morbidity, operative mortality, longer hospital stays, and higher costs.
- Increasing DCI independently predicted higher operative mortality in IE patients (OR 1.24 per quartile increase, P < 0.001).
- Patients with tricuspid/pulmonic valve endocarditis had significantly worse mean DCI than those with left-sided endocarditis.
Conclusions:
- The DCI is an independent predictor of increased risk-adjusted mortality and resource utilization in IE.
- Incorporating SES into risk prediction models can improve accuracy for IE patients.
- Considering socioeconomic factors is crucial for effective resource allocation in endocarditis care.
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