BACKGROUND: Health disparities have been associated with the prevalence of cardiovascular disease. In cardiac surgery, association has been found between race, sex, and poorer prognosis after surgery. However, there is a complex interplay between race, sex, and socioeconomic position (SEP). In our investigation we sought to identify which of these was the driver of risk-adjusted survival. METHODS AND RESULTS: From January 1, 1995, and December 30, 2005, 23 330 patients (15 156 white men, 6932 white women, 678 black men, and 564 black women) underwent isolated coronary artery bypass grafting, valve, or combined coronary artery bypass grafting and valve procedures. Median follow-up was 5.8 years (25th and 75th percentiles: 3 and 8.6 years). Effect of race, sex, and SEP on all-cause mortality was examined with 2-phase Cox model and generalized propensity score technique. As expected, blacks and women had lower SEP as compared with whites and men for all 6 SEP indicators. Patients with lower SEP had more atherosclerotic disease burden, more comorbidity, and were more symptomatic. Lower SEP was associated with a risk-adjusted dose-dependent reduction in survival after surgery (men, P<0.0001; women, P=0.0079), but black race, once adjusted for SEP, was not. CONCLUSIONS: Our large investigation demonstrates that disparities in SEP are present and significantly affect health outcomes. Although race per se was not the driver for reduced survival, patients of low SEP were predominantly represented by blacks and women. Socioeconomically disadvantaged patients had significantly higher risk-adjusted mortality after surgery. Further investigation and targeted intervention should focus specifically on patients of low SEP, their health behaviors, and secondary prevention efforts.
BACKGROUND: Health disparities have been associated with the prevalence of cardiovascular disease. In cardiac surgery, association has been found between race, sex, and poorer prognosis after surgery. However, there is a complex interplay between race, sex, and socioeconomic position (SEP). In our investigation we sought to identify which of these was the driver of risk-adjusted survival. METHODS AND RESULTS: From January 1, 1995, and December 30, 2005, 23 330 patients (15 156 white men, 6932 white women, 678 black men, and 564 black women) underwent isolated coronary artery bypass grafting, valve, or combined coronary artery bypass grafting and valve procedures. Median follow-up was 5.8 years (25th and 75th percentiles: 3 and 8.6 years). Effect of race, sex, and SEP on all-cause mortality was examined with 2-phase Cox model and generalized propensity score technique. As expected, blacks and women had lower SEP as compared with whites and men for all 6 SEP indicators. Patients with lower SEP had more atherosclerotic disease burden, more comorbidity, and were more symptomatic. Lower SEP was associated with a risk-adjusted dose-dependent reduction in survival after surgery (men, P<0.0001; women, P=0.0079), but black race, once adjusted for SEP, was not. CONCLUSIONS: Our large investigation demonstrates that disparities in SEP are present and significantly affect health outcomes. Although race per se was not the driver for reduced survival, patients of low SEP were predominantly represented by blacks and women. Socioeconomically disadvantaged patients had significantly higher risk-adjusted mortality after surgery. Further investigation and targeted intervention should focus specifically on patients of low SEP, their health behaviors, and secondary prevention efforts.
Authors: Fenton H McCarthy; Lingjiao Zhang; Vicky Tam; Jinbo Chen; Chase Brown; William L Patrick; Walter Clark Hargrove; Wilson Y Szeto; Nimesh D Desai; Douglas J Wiebe; Peter W Groeneveld; Matthew L Williams Journal: Am J Cardiol Date: 2018-09-26 Impact factor: 2.778
Authors: Andrew M Davis; Michael S Taitel; Jenny Jiang; Dima M Qato; Monica E Peek; Chia-Hung Chou; Elbert S Huang Journal: J Racial Ethn Health Disparities Date: 2016-06-28
Authors: Eric J Charles; J Hunter Mehaffey; Robert B Hawkins; Clifford E Fonner; Leora T Yarboro; Mohammed A Quader; Andy C Kiser; Jeffrey B Rich; Alan M Speir; Irving L Kron; Margaret C Tracci; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2019-01-22 Impact factor: 4.330
Authors: Sumeet Subherwal; Manesh R Patel; Fengming Tang; Kim G Smolderen; W Schuyler Jones; Thomas T Tsai; Henry H Ting; Deepak L Bhatt; John A Spertus; Paul S Chan Journal: J Am Coll Cardiol Date: 2013-05-02 Impact factor: 24.094
Authors: Jimmy T Efird; Wesley T O'Neal; Curtis A Anderson; Jason B O'Neal; Linda C Kindell; T Bruce Ferguson; W Randolph Chitwood; Alan P Kypson Journal: Front Public Health Serv Syst Res Date: 2013-04-03
Authors: Salene M W Jones; Matthew P Banegas; John F Steiner; Emilia H De Marchis; Laura M Gottlieb; Adam L Sharp Journal: J Gen Intern Med Date: 2021-01-19 Impact factor: 6.473