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| Title: | Area socioeconomic status and mortality after coronary artery bypass graft surgery: the role of hospital volume |
| Authors: | Kim, C
Diez Roux, AV
Hofer, TP
Nallamothu, BK
Bernstein, SJ
Rogers, MA |
| Issue Date: | 2007 |
| Publisher: | American Heart Journal |
| Citation: | American Heart Journal. 2007(August):154(152):385-190 <http://hdl.handle.net/2027.42/57782> |
| Abstract: | Background
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.
Methods
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.
Results
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.
Conclusions
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. |
| Appears in Collections: | Epidemiology, Department of (SPH)
Health Management and Policy, Department of (SPH-HMP)
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| Area Socioeconomic status and mortality after coronary artery bypass graft surgery The role of hospital volume.pdf | | 116Kb | Adobe PDF | View/Open |
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