Association Between Geographic Measures of Socioeconomic Status and Deprivation and Major Surgical Outcomes.

Abstract

There is evidence suggesting higher rates of negative surgical outcomes for patients with lower socioeconomic status. The objective of this study was to evaluate the effects of different geographic measures of socioeconomic status and deprivation on surgical outcomes in the United States. We extracted county-level, zip code-level, census block group-level and census tract-level measures of geographic risk. We evaluated associations between geographic area inequity and surgical outcomes using linear, logistic, and Poisson regression with generalized estimating equations to account for clustering by hospital. Hospital discharges (n=1,573,740) after major surgery in Arizona, Florida, Iowa, Michigan, New Jersey, New York, North Carolina, and Vermont as extracted from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database between the years 2010-2012. Inpatient mortality, length of stay, hospital costs, discharge status, and 30-day all-cause readmission. After adjusting for patient, hospital, and discharge factors, the odds of inpatient mortality significantly increased as geographic distress increased across all measures of geographic risk. Odds of routine discharge increased and the odds of 30-day all-cause readmission decreased with geographic distress for select measures of geographic inequity. The choice of measure generally did not affect the findings; the results did not conclusively support the use of measures from larger or smaller geographic units. There is a consistent, strong association between geographic indicators for socioeconomic status and distress with important surgical outcomes. Further work is needed to understand the source of these associations and to develop interventions and effective policies to address them.