Social deprivation was an independent predictor of mid-term mortality after cardiac surgery (HR 1.024; 95% CI 1.015-1.033; P<0.001), even after adjusting for smoking, BMI, and diabetes.
Observational (n=44,902)
Yes
Does social deprivation increase the risk of mortality in adults undergoing cardiac surgery?
Social deprivation is an independent predictor of increased mid-term mortality after cardiac surgery, an effect that is only partially explained by modifiable risk factors like smoking, BMI, and diabetes.
Hazard Ratio: 1.024 (95% CI 1.015–1.033)
p-value: p=<0.001
OBJECTIVE: To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors. DESIGN: Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points. SETTING: Birmingham and north west England. PARTICIPANTS: 44 902 adults undergoing cardiac surgery, 1997-2007. MAIN OUTCOME MEASURES: Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up. RESULTS: In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001). CONCLUSIONS: Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.
Pagano et al. (2009) conducted an observational in cardiac surgery (n=44,902). Social deprivation was evaluated on All cause mortality at mid-term follow-up (HR 1.024, 95% CI 1.015-1.033, p=<0.001). Social deprivation was an independent predictor of mid-term mortality after cardiac surgery (HR 1.024; 95% CI 1.015-1.033; P<0.001), even after adjusting for smoking, BMI, and diabetes.