Abstract
BackgroundThe impact of socioeconomic disparities on surgical outcome in the absence of healthcare inequality remains unclear. Therefore, we set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. Additionally, we aim to assess whether SES is associated with cause-specific survival and major 30-day complications.MethodsPatients undergoing surgery between March 2005 and December 2006 in a general teaching hospital in the Netherlands were prospectively included. Adjusted logistic and cox regression analyses were used to assess the independent association of SES–quantified by gross household income–with major 30-day complications and long-term postoperative survival.ResultsA total of 3929 patients were included, with a median follow-up of 6.3 years. Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01–1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08–2.31, first [i.e. lowest] quartile relative to the fourth quartile). Similarly, low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07–1.48, first income quartile: HR: 3.10, 95% CI: 1.04–9.22). Household income was not independently associated with cancer-related mortality and major 30-day complications.ConclusionsLow SES, quantified by gross household income, is associated with increased overall and cardiovascular mortality risks among surgical patients. Considering the equality of care provided by this study setting, the associated survival hazards can be attributed to patient and provider factors, rather than disparities in healthcare. Increased physician awareness of SES as a risk factor in preoperative decision-making and focus on improving established SES-related risk factors may improve surgical outcome of low SES patients.
Highlights
The relation between socioeconomic status (SES) and outcome of medical treatment has been the subject of many studies over the past years, and SES-related risks of poor outcome have been demonstrated previously.[1,2,3,4,5,6,7,8,9] A considerable number of these studies were performed in countries where healthcare is not publicly provided
Low household income was associated with worse survival in continuous analysis (HR: 1.05 per 10.000 euro decrease in income, 95% CI: 1.01–1.10) and in income quartile analysis (HR: 1.58, 95% CI: 1.08–2.31, first [i.e. lowest] quartile relative to the fourth quartile)
Low income patients were at higher risk of cardiovascular death (HR: 1.26 per 10.000 decrease in income, 95% CI: 1.07–1.48, first income quartile: higher mortality risks (HR): 3.10, 95% CI: 1.04–9.22)
Summary
The relation between socioeconomic status (SES) and outcome of medical treatment has been the subject of many studies over the past years, and SES-related risks of poor outcome have been demonstrated previously.[1,2,3,4,5,6,7,8,9] A considerable number of these studies were performed in countries where healthcare is not publicly provided. The relation between SES and outcome is multifactorial and complex, differences in outcome between socioeconomic classes were attributed more to differences in accessibility and provision of care in some of these studies, rather than patient factors or healthcare provider factors.[1, 6, 9,10,11]. Due to the healthcare equality, differences in outcome associated with SES can under these circumstances be attributed to patient and provider factors and their interaction, rather than disparities in healthcare. We set out to determine the association between socioeconomic status (SES), reflected by household income, and overall survival after surgery in the Dutch setting of equal access and provision of care. We aim to assess whether SES is associated with cause-specific survival and major 30-day complications
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