Abstract
Background: Population aging results in increased volume of aortic stenosis (AS) patients. Although, income is an independent factor of operative mortality for patients undergoing aortic valve surgery in the US, it remains unknown to date whether individual income affects treatment decision to undergo surgery and survivorship after surgery under the universal health coverage in Japan. Methods: Using the Japanese Diagnosis Procedure Combination database, we extracted a total of 16079 isolated AS patients aged ≥ 65 years hospitalized between July 2010 and March 2012. Individual income was represented by patients’ residential mean household income. Income was categorized into quartiles with approximately equal numbers of patients. First, decision over undergoing valve surgery was regressed on income level with adjustments for hospital volume, regional medical supplying factor and patients’ individual variables. Moreover, survivorship was regressed on income level with adjustment for types of surgery and combined surgery besides the abovementioned variables. Results: Of the 16079 AS patients, 6803 underwent aortic valve surgery. In the multivariable regression analysis for decision over undergoing surgery, the odds ratios for the 2nd, 3rd, 4th quartiles with reference to the 1st quartile of income were 0.79[95% CI: 0.61-1.02], 0.90[0.69-1.17], 0.99[0.77-1.28], respectively. In the multivariable regression analysis for post-operative mortality, the odds ratios for the 2nd, 3rd, 4th quartiles were 1.47 [0.47-4.6], 1.10 [0.30-3.70] and 1.50 [0.50-4.60], respectively. Hospital volume was significantly associated with higher likelihood of surgical intervention and lower post-operative mortality. Conclusions: Under universal health coverage in Japan, treatment decision for surgical intervention and postoperative survivorship of aortic valve surgery was equal regardless of patients’ income levels, while hospital volumes exerted a significant influence on the treatment choice and the outcome of the surgery.
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