Journal article
Area socioeconomic status and mortality after coronary artery bypass graft surgery: The role of hospital volume
The American heart journal, v 154(2), pp 385-390
Aug 2007
PMID: 17643593
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Individuals of low socioeconomic status (SES) have reduced access to coronary artery bypass graft surgery (CABG). It is unknown if low-SES CABG patients have reduced access to hospitals with better outcomes.
We conducted a retrospective cohort analysis of the California CABG Mortality Reporting Program, consisting of individuals with zip code information who underwent CABG at participating hospitals in 1999-2000 (n = 18
961). Primary outcome measures were inhospital mortality after CABG; primary independent variables of interest were area-level SES, clinical risk factors, and hospital volume. We used 2-level hierarchical random-effects logit models to estimate the relationship between explanatory variables and inhospital mortality.
Within high-volume hospitals, patients of low-SES areas had greater mortality than those of mid- and high-SES areas (2.5% vs 1.5% vs 1.8%,
P = .024). However, there was no relationship between SES and mortality in lower-volume hospitals. Contrary to expectations, individuals of high-SES areas (42%) underwent surgery at low-volume hospitals more often than patients of low-SES areas (28%,
P < .001), although mortality at low-volume hospitals was greater than that at high-volume facilities (
P < .001). Discrepancies were not explained by distance traveled.
Mortality after CABG is modified by both SES and hospital volume. Within high-volume hospitals, patients of low-SES areas fared worse than patients of higher-SES areas. Patients of high SES tended to have CABG surgery at low-volume hospitals where mortality was greater and therefore had higher mortality than expected.
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Details
- Title
- Area socioeconomic status and mortality after coronary artery bypass graft surgery: The role of hospital volume
- Creators
- Catherine Kim (Corresponding Author) - University of MichiganAna V. Diez Roux - University of MichiganTimothy P. Hofer - Michigan MedicineBrahmajee K. Nallamothu - University of MichiganSteven J. Bernstein - VA Ann Arbor Healthcare SystemMary A.M. Rogers - University of Michigan
- Publication Details
- The American heart journal, v 154(2), pp 385-390
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000248511000029
- Scopus ID
- 2-s2.0-34447502117
- Other Identifier
- 991020112159504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems