Abstract 17079: Lower Socioeconomic Status Portends Higher Long Term Mortality Following Isolated Mitral Valve Surgery

Abstract

Introduction: Lower socioeconomic status (SES) has been associated with worse outcomes in patients undergoing cardiac surgery; however, this has not been fully elucidated in mitral valve (MV) surgery. We sought to determine the effect of SES on short-term outcomes and long-term mortality following MV surgery. Hypothesis: Lower SES is associated with higher mortality following isolated MV surgery. Methods: Retrospective analysis of our institution’s MV database was performed between November 1998 and March 2019 for all adult patients undergoing isolated MV surgery in our state and 4 neighboring states. Patients for whom address data was missing were excluded. SES was determined by the Area Deprivation Index (ADI). The ADI uses 17 social determinants of heath to estimate the average SES for all US Census Block Groups (mean 1500 people). This score is then nationally indexed from 1 to 100, with lower SES represented by higher scores. Patients were stratified by ADI quartiles. Baseline characteristics and postoperative outcomes were compared between quartiles. Results: Overall, 3,860 surgeries met inclusion criteria during the study period. Of these, 1,795 (46.5%) patients fell into the lowest ADI quartile, 1,216 (31.5%) in the second quartile, 476 (12.3%) in the third quartile, and 344 (8.9%) in the highest quartile. 30-day mortality was not significantly different between ADI quartiles and ADI was not a significant determinate of 30-day survival in a multivariable logistical regression. Figure 1 show the distribution of patient addresses within Census Block Groups as well as 10-year survival by Kaplan-Meier estimates, stratified by ADI quartiles. Cox proportional hazards model revealed that lower SES as determined by ADI was associated with increased 10-year mortality (P = 0.008). Conclusions: Lower SES is associated with worse long-term survival in patients undergoing isolated MV surgery. Social interventions to bridge this survival gap are warranted.