Area socioeconomic status and mortality after coronary artery bypass graft surgery: the role of hospital volume
dc.contributor.author | Kim, C. | |
dc.contributor.author | Diez Roux, Ana V. | |
dc.contributor.author | Hofer, Timothy P. | |
dc.contributor.author | Nallamothu, Brahmajee K. | |
dc.contributor.author | Bernstein, Steven J. | |
dc.contributor.author | Rogers, Mary A. M. | |
dc.date.accessioned | 2008-01-29T19:31:01Z | |
dc.date.available | 2008-01-29T19:31:01Z | |
dc.date.issued | 2007 | |
dc.identifier.citation | American Heart Journal. 2007(August):154(152):385-190 <http://hdl.handle.net/2027.42/57782> | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/57782 | |
dc.description.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. | en_US |
dc.format.extent | 119782 bytes | |
dc.format.mimetype | application/pdf | |
dc.language.iso | en_US | en_US |
dc.publisher | American Heart Journal | en_US |
dc.title | Area socioeconomic status and mortality after coronary artery bypass graft surgery: the role of hospital volume | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Public Health | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.contributor.affiliationum | Epidemiology, Department of | en_US |
dc.contributor.affiliationumcampus | Ann Arbor | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/57782/1/Area Socioeconomic status and mortality after coronary artery bypass graft surgery The role of hospital volume.pdf | en_US |
dc.owningcollname | Epidemiology, Department of (SPH) |
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