Identifying the origin of socioeconomic disparities in outcomes of major elective operations

Catherine G. Williamson · Shannon Richardson · Shayan Ebrahimian · Elsa Kronen · Arjun Verma · Peyman Benharash

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Health disparities and outcomes Healthcare Policy and Management Cardiac, Anesthesia and Surgical Outcomes

Abstract

While the impact of socioeconomic status (SES) on surgical outcomes has been examined in limited series, it remains a significant determinant of healthcare outcomes at the national level. Therefore, the current study aims to determine SES disparities at three time-points: hospital accessibility, in-hospital outcomes, and post-discharge consequences. The Nationwide Readmissions Database 2010–2018 was used to isolate major elective operations. SES was assigned using previously coded median income quartiles as defined by patient zip-code, with low SES defined as the lowest quartile and high SES as the highest. Of an estimated 4,816,837 patients undergoing major elective operations, 1,037,689 (21.3 %) were categorized as low SES and 1,288,618 (26.5 %) as high. On univariate analysis and compared to those of low SES, high SES patients were more frequently treated at high-volume centers (70.9 vs 55.6 %, p < 0.001), had lower rates of in-hospital complications (24.0 vs 29.0 %, p < 0.001) and mortality (0.4 vs 0.9 %, p < 0.001) as well as less frequent urgent readmissions at 30- (5.7 vs 7.1 %, p < 0.001) and 90-day timepoints (9.4 vs 10.7 %, p < 0.001). On multivariable analysis, high SES patients had higher odds of treatment at high-volume centers (Odds: 1.87, 95 % CI: 1.71–2.06), and lower odds of perioperative complications (Odds: 0.98, 95 % CI: 0.96–0.99), mortality (Odds: 0.70, 95 % CI: 0.65–0.75), and urgent readmissions at 90-days (Odds: 0.95, 95 % CI: 0.92–0.98). This study fills a much-needed gap in the current literature by establishing that all of the aforementioned timepoints include significant disadvantages for those of low socioeconomic status. Therefore, a multidisciplinary approach may be required for intervention to improve equity for surgical patients.

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References

2010Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us 2013Racial Disparities in Surgical Care and Outcomes in the United States: A Comprehensive Review of Patient, Provider, and Systemic Factors 2016Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States 2006Race and Surgical Mortality in the United States 2016Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study 2014Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital 2015Effect of Hospital Safety-Net Burden on Cost and Outcomes After Surgery 2008Socioeconomic Status and Surgical Mortality in the Elderly

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