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Patient Socioeconomic Status Is an Independent Predictor of Operative Mortality

2010; Lippincott Williams & Wilkins; Volume: 252; Issue: 3 Linguagem: Inglês

10.1097/sla.0b013e3181f2ac64

1528-1140

Kyla M. Bennett, John Scarborough, Theodore N. Pappas, Thomas B. Kepler,

Healthcare cost, quality, practices

In Brief Objective: To evaluate the impact of patient socioeconomic status (SES) on operative mortality within the context of associated factors. Summary of Background Data: Outcomes disparities among surgical patients are a significant concern. Previous studies have suggested that the correlation between SES and outcomes is attributable to other patient- or hospital-level explanatory factors such as race or hospital wealth. These studies have typically focused on a single explanation for the existence of these inequalities. Methods: Analyzing more than 1 million records of the Nationwide Inpatient Sample, we used multimodel inference to evaluate the effects of socioeconomic predictors on surgical mortality. Results: Using univariate and multivariate logistic regression, we find that patient's SES is a strong predictor of operative mortality. Multivariate regressions incorporated many additional hospital- and patient-level covariates. A single-level increase in patient SES results in a mean decrease in operative mortality risk of 7.1%. Conclusions: SES at the level of the individual patient has a statistically significant effect on operative mortality. Mortality is greatest among patients in the lowest socioeconomic strata. The effect of patient SES on mortality is not mitigated by other explanatory hospital- or patient-level factors. Patients of low socioeconomic strata experience higher operative mortality rates. This effect is not attributable to other patient- or hospital-level explanatory factors.