The Contemporary Status of Socioeconomic Based Disparities in Cardiac Surgery: Are We Closing the Disparities Gap?
Paige Newell MD1, Sainath Asokan MS2, Anagha Prasanna BS1, Sameer Hirji MD, MPH1, Morgan Harloff MD1, Edward Percy MD3, Mariam Kerolos BS1, Tsuyoshi Kaneko MD1
1Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; 2Boston University School of Medicine, Boston, MA; 3University of British Columbia Department of Cardiovascular Surgery, Vancouver, CA
Female sex and lower income are associated with worse healthcare outcomes. This study analyzes the national, contemporary status of socioeconomic disparities in cardiac surgery.
Adult patients within the Nationwide Readmissions Database who underwent coronary artery bypass graft (CABG), surgical aortic valve replacement (SAVR), mitral valve replacement (MVR), MV repair, or ascending aorta surgery in 2016-2018 were included. Sex and median household income quartile were compared within each surgery. Primary outcome was 30-day mortality. Multivariable analysis adjusted for patient characteristics and hospital-level factors.
A weighted total of 358,762 patients were included. Fewer females underwent CABG (22.3%), SAVR (32.2%), MV repair (37.5%), and ascending aorta surgery (29.7%). On adjusted analysis, female sex was independently associated with increased 30-day mortality following CABG (aOR 1.8), SAVR (aOR 1.5), and ascending aorta surgery (aOR 1.3)(all p < 0.001). The lowest median household income quartile was independently associated with increased 30-day mortality following CABG (aOR 1.4), SAVR (aOR 1.6), MVR (aOR 1.4), and ascending aorta surgery (aOR 1.8)(all p<0.001) compared to the highest quartile. Patients of lower-income quartiles received less care at urban and academic institutions for all surgeries.
Despite advances in the techniques and safety, females and patients of lower socioeconomic status continue to have worse outcomes following cardiac surgery. These persistent disparities warrant the need for root cause analysis.
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