Wan, YI;
McGuckin, D;
Fowler, AJ;
Prowle, JR;
Pearse, RM;
Moonesinghe, SR;
(2021)
Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies.
British Journal of Anaesthesia
, 126
(3)
pp. 642-651.
10.1016/j.bja.2020.10.019.
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Abstract
BACKGROUND: Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS). METHODS: We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals. RESULTS: Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17–1.78]; P<0.001), IMD2 (OR=1.38 [1.12–1.70]; P<0.01), IMD3 (OR=1.09 [0.88–1.35]: P=0.44), IMD4 (OR=0.89 [0.71–1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23–1.67]; P<0.0001), IMD2 (HR=1.35 [1.15–1.57]; P<0.001), IMD3 (HR=1.04 [0.89–1.23]; P=0.60), and IMD4 (HR=1.11 [0.95–1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival. CONCLUSIONS: Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.
| Type: | Article |
|---|---|
| Title: | Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.bja.2020.10.019 |
| Publisher version: | https://doi.org/10.1016/j.bja.2020.10.019 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | healthcare disparities, mortality, postoperative complications, socioeconomic factors, surgery, survival |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10158747 |
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