The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery

Lovette Azap; Selamawit Woldesenbet; Henrique Lima; Muhammad Musaab Munir; Adrian Diaz; Yutaka Endo; Jason Yang; Nahush A Mokadam; Asvin Ganapathi; Timothy M Pawlik

doi:10.1016/j.jss.2023.07.030

The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery

J Surg Res. 2023 Dec:292:30-37. doi: 10.1016/j.jss.2023.07.030. Epub 2023 Aug 10.

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio; Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
² Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio.
³ Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
⁴ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, Ohio. Electronic address: Tim.Pawlik@osumc.edu.

PMID: 37572411
DOI: 10.1016/j.jss.2023.07.030

Abstract

Introduction: We sought to evaluate the association of county-level poverty duration and cardiac surgical outcomes.

Methods: Patients who underwent coronary artery bypass graft, surgical aortic valve replacement, and mitral valve repair and replacement between 2016 and 2020 were identified using the Medicare Standard Analytical Files Database. County-level poverty data were acquired from the American Community Survey and US Department of Agriculture (1980-2015). High poverty was defined as ≥19.5% of residents in poverty. Patients were stratified into never-high poverty (NHP), intermittent low poverty, intermittent high poverty, and persistent poverty (PP). A mixed-effect hierarchical generalized linear model and Cox regression models that adjusted for patient-level covariates were used to evaluate outcomes.

Results: Among 237,230 patients, 190,659 lived in NHP counties, while 10,273 resided in PP counties. Compared with NHP patients, PP patients were more likely to present at a younger median age (NHP: 75 y versus PP: 74 y), be non-Hispanic Black (5388, 2.9% versus PP: 1030, 10.1%), and live in the south (NHP: 66,012, 34.6% versus PP: 87,815, 76.1%) (all P < 0.001). PP patients also had more nonelective surgical operations (NHP: 58,490, 30.8% versus 3645, 35.6%, P < 0.001). Notably, PP patients had increased odds of 30-d mortality (odds ratio 1.13, 95% confidence interval [CI] 1.02-1.26), 90-d mortality (odds ratio 1.14, 95% CI 1.05-1.24), and risk of long-term mortality (hazard ratio 1.13, 95% CI 1.09-1.19) compared with patients in NHP counties (all P < 0.05).

Conclusions: County-level poverty was associated with a greater risk of short- and long-term mortality among cardiac surgical patients.

Keywords: Cardiac; Outcomes; Poverty; Social determinants; Surgery.