Lower socioeconomic position, but not black race, was associated with a risk-adjusted dose-dependent reduction in survival after cardiac surgery (P<0.0001 for men; P=0.0079 for women).
Cohort (n=23,330)
Does lower socioeconomic position, rather than race, reduce risk-adjusted survival in patients undergoing cardiac surgery?
Socioeconomic position, rather than race, is the primary driver of reduced risk-adjusted survival after cardiac surgery, highlighting the need for targeted interventions in socioeconomically disadvantaged patients.
p-value: p=<0.0001 (men), 0.0079 (women)
BACKGROUND: Health disparities have been associated with the prevalence of cardiovascular disease. In cardiac surgery, association has been found between race, sex, and poorer prognosis after surgery. However, there is a complex interplay between race, sex, and socioeconomic position (SEP). In our investigation we sought to identify which of these was the driver of risk-adjusted survival. METHODS AND RESULTS: From January 1, 1995, and December 30, 2005, 23 330 patients (15 156 white men, 6932 white women, 678 black men, and 564 black women) underwent isolated coronary artery bypass grafting, valve, or combined coronary artery bypass grafting and valve procedures. Median follow-up was 5.8 years (25th and 75th percentiles: 3 and 8.6 years). Effect of race, sex, and SEP on all-cause mortality was examined with 2-phase Cox model and generalized propensity score technique. As expected, blacks and women had lower SEP as compared with whites and men for all 6 SEP indicators. Patients with lower SEP had more atherosclerotic disease burden, more comorbidity, and were more symptomatic. Lower SEP was associated with a risk-adjusted dose-dependent reduction in survival after surgery (men, P<0.0001; women, P=0.0079), but black race, once adjusted for SEP, was not. CONCLUSIONS: Our large investigation demonstrates that disparities in SEP are present and significantly affect health outcomes. Although race per se was not the driver for reduced survival, patients of low SEP were predominantly represented by blacks and women. Socioeconomically disadvantaged patients had significantly higher risk-adjusted mortality after surgery. Further investigation and targeted intervention should focus specifically on patients of low SEP, their health behaviors, and secondary prevention efforts.
Koch et al. (Wed,) conducted a cohort in Cardiac surgery (n=23,330). Lower socioeconomic position (SEP) vs. Higher socioeconomic position was evaluated on All-cause mortality (p=<0.0001 (men), 0.0079 (women)). Lower socioeconomic position, but not black race, was associated with a risk-adjusted dose-dependent reduction in survival after cardiac surgery (P<0.0001 for men; P=0.0079 for women).