Effect of Socioeconomic Distress on Risk-Adjusted Mortality After Valve Surgery for Infective Endocarditis

Raymond J Strobel; Eric J Charles; J Hunter Mehaffey; Robert B Hawkins; Mohammed A Quader; Jeffrey B Rich; Alan M Speir; Gorav Ailawadi; Investigators for the Virginia Cardiac Services Quality Initiative

doi:10.1053/j.semtcvs.2022.05.007

Effect of Socioeconomic Distress on Risk-Adjusted Mortality After Valve Surgery for Infective Endocarditis

Semin Thorac Cardiovasc Surg. 2023;35(3):497-507. doi: 10.1053/j.semtcvs.2022.05.007. Epub 2022 May 16.

Authors

Raymond J Strobel¹, Eric J Charles¹, J Hunter Mehaffey¹, Robert B Hawkins², Mohammed A Quader³, Jeffrey B Rich⁴, Alan M Speir⁵, Gorav Ailawadi⁶; Investigators for the Virginia Cardiac Services Quality Initiative

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
² Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
³ Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
⁴ Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
⁵ Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia.
⁶ Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: ailawadi@umich.edu.

PMID: 35588950
DOI: 10.1053/j.semtcvs.2022.05.007

Abstract

Infective endocarditis affects patients of all socioeconomic status. We hypothesized that the Distressed Communities Index (DCI), a comprehensive assessment of socioeconomic status, would be associated with risk-adjusted mortality for patients with endocarditis. All patients with endocarditis (2001-2017) in a regional Society of Thoracic Surgeons database were analyzed. DCI scores range from 0 (no socioeconomic distress) to 100 (severe distress) and account for unemployment, poverty rate, median income, housing vacancies, education level, and business growth by zip code. The most distressed patients (top quartile, DCI > 75) were compared to all other patients. Hierarchical logistic regression modeled the association between DCI and mortality. A total of 2,075 patients were included (median age 55 years, 65.2% urgent/emergent cases, 42.7% self-pay). Major morbidity was 32.8% and operative mortality was 9.5%. Tricuspid/pulmonic valve endocarditis was present in 12.5% of cases, with significantly worse mean DCI compared to patients with left-sided endocarditis (median 55.3, IQR 20.3-77.6 vs 46.8, IQR 17.3-74.2, P = 0.016). High socioeconomic distress (DCI > 75) was associated with higher rates of major morbidity, operative mortality, increased length of stay, and higher total cost. After risk-adjustment, DCI was independently predictive of higher operative mortality for patients with endocarditis (OR 1.24 per DCI quartile increase, 95% CI 1.06-1.45, P < 0.001). Increasing DCI, an indicator of poor socioeconomic status, independently predicts increased risk-adjusted mortality and resource utilization for patients with endocarditis. Accounting for socioeconomic status allows for more accurate risk prediction and resource allocation for patients with endocarditis.

Keywords: Disparities; Endocarditis; Outcomes.