K H J Ultee1, F Bastos Gonçalves2, S E Hoeks3, E V Rouwet1, E Boersma4, R J Stolker3, H J M Verhagen5. 1. Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands. 2. Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 3. Department of Anaesthesiology, Erasmus University Medical Center, The Netherlands. 4. Department of Cardiology, Thorax Center, Erasmus University Medical Center, The Netherlands. 5. Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands. Electronic address: h.verhagen@erasmusmc.nl.
Abstract
OBJECTIVE/ BACKGROUND: The association between socioeconomic status (SES), presentation, and outcome after vascular surgery is largely unknown. This study aimed to determine the influence of SES on post-operative survival and severity of disease at presentation among vascular surgery patients in the Dutch setting of equal access to and provision of care. METHODS: Patients undergoing surgical treatment for peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), or carotid artery stenosis between January 2003 and December 2011 were retrospectively included. The association between SES, quantified by household income, disease severity at presentation, and survival was studied using logistic and Cox regression analysis adjusted for demographics, and medical and behavioral risk factors. RESULTS: A total of 1,178 patients were included. Low income was associated with worse post-operative survival in the PAD cohort (n = 324, hazard ratio 1.05, 95% confidence interval [CI] 1.00-1.10, per 5,000 Euro decrease) and the AAA cohort (n = 440, quadratic relation, p = .01). AAA patients in the lowest income quartile were more likely to present with a ruptured aneurysm (odds ratio [OR] 2.12, 95% CI 1.08-4.17). Lowest income quartile PAD patients presented more frequently with symptoms of critical limb ischemia, although no significant association could be established (OR 2.02, 95% CI 0.96-4.26). CONCLUSIONS: The increased health hazards observed in this study are caused by patient related factors rather than differences in medical care, considering the equality of care provided by the study setting. Although the exact mechanism driving the association between SES and worse outcome remains elusive, consideration of SES as a risk factor in pre-operative decision making and focus on treatment of known SES related behavioral and psychosocial risk factors may improve the outcome of patients with vascular disease.
OBJECTIVE/ BACKGROUND: The association between socioeconomic status (SES), presentation, and outcome after vascular surgery is largely unknown. This study aimed to determine the influence of SES on post-operative survival and severity of disease at presentation among vascular surgery patients in the Dutch setting of equal access to and provision of care. METHODS:Patients undergoing surgical treatment for peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), or carotid artery stenosis between January 2003 and December 2011 were retrospectively included. The association between SES, quantified by household income, disease severity at presentation, and survival was studied using logistic and Cox regression analysis adjusted for demographics, and medical and behavioral risk factors. RESULTS: A total of 1,178 patients were included. Low income was associated with worse post-operative survival in the PAD cohort (n = 324, hazard ratio 1.05, 95% confidence interval [CI] 1.00-1.10, per 5,000 Euro decrease) and the AAA cohort (n = 440, quadratic relation, p = .01). AAA patients in the lowest income quartile were more likely to present with a ruptured aneurysm (odds ratio [OR] 2.12, 95% CI 1.08-4.17). Lowest income quartile PAD patients presented more frequently with symptoms of critical limb ischemia, although no significant association could be established (OR 2.02, 95% CI 0.96-4.26). CONCLUSIONS: The increased health hazards observed in this study are caused by patient related factors rather than differences in medical care, considering the equality of care provided by the study setting. Although the exact mechanism driving the association between SES and worse outcome remains elusive, consideration of SES as a risk factor in pre-operative decision making and focus on treatment of known SES related behavioral and psychosocial risk factors may improve the outcome of patients with vascular disease.
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: Erica C Leifheit; Yun Wang; George Howard; Virginia J Howard; Larry B Goldstein; Thomas G Brott; Judith H Lichtman Journal: Neurology Date: 2018-09-28 Impact factor: 11.800
Authors: Klaas H J Ultee; Elke K M Tjeertes; Frederico Bastos Gonçalves; Ellen V Rouwet; Anton G M Hoofwijk; Robert Jan Stolker; Hence J M Verhagen; Sanne E Hoeks Journal: PLoS One Date: 2018-01-22 Impact factor: 3.240
Authors: I van den Berg; S Buettner; R R J Coebergh van den Braak; K H J Ultee; H F Lingsma; J L A van Vugt; J N M Ijzermans Journal: J Gastrointest Surg Date: 2019-11-19 Impact factor: 3.267