Impact Of Socioeconomic Deprivation Research Articles

Impact of Socioeconomic Deprivation and Area of Residence on Access to Coronary Revascularization and Mortality After a First Acute Myocardial Infarction in Québec

BackgroundSocioeconomic status (SES) and area of residence are known to impact access to invasive cardiac procedures. Low SES adversely affects long-term mortality after acute myocardial infarction (AMI). Most of the data were derived from private healthcare systems. Our objectives were to evaluate the effects of SES and area of residence on access to coronary angiography, revascularization and mortality after a first AMI in a publicly-funded healthcare system with a high supply of catheterization facilities. MethodsQuébec administrative databases were used to identify all patients with a first AMI between 1997 and 2001. The SES was determined with the population deprivation index, which has 2 dimensions: material and social. Six-month access to angiography, revascularization and 1-year mortality were considered in proportional hazards survival regression analyses measuring the effect of deprivation and the geographical area of residence, accounting for several other covariates. ResultsThe study cohort consisted of 50,242 patients. The most materially and socially deprived patients had a 16% (95% confidence interval [CI], 1.08-1.25) and 13% (95% CI, 1.05-1.21) relative increased hazard of dying within 1 year respectively compared with the most privileged subjects. This mortality gradient could not be explained by meaningful differences in access to angiography or revascularization. Geography did not influence access to revascularization procedures. ConclusionsDespite universal healthcare system, SES measured with a material and social deprivation index, had significant adverse effect on 1-year mortality after a first AMI. Such findings were not explained by lower access to coronary angiography or revascularization.

The relationship between socioeconomic deprivation and metabolic/cardiovascular risk factors in a cohort of patients with type 2 diabetes mellitus

Aim There is conflicting information on the impact of socioeconomic deprivation on outcomes in diabetes. Our aim was to study the relationship between socioeconomic deprivation and clinical outcome indicators in a patient cohort with type 2 diabetes mellitus [T2DM]. Methods We recruited a random sample of 446 patients with T2DM [57% male] stratified by Income Deprivation Measure. Data on patient specific socioeconomic status, educational attainment, behaviour and attitudes were gathered by patient interview. Data analysis was by logistic and linear regression with correction for age, gender and duration of diabetes. Results The study cohort showed high levels of deprivation with 80% reporting a household annual income of <£20,000 and 69.5% having no formal educational qualification. The cohort was actively managed with high usage of lipid lowering [90.1%], antihypertensive [80.6%] and antiplatelet agents [78%] and correspondingly good control of modifiable risk factors: HbA1c 7.6 [1.4]%, systolic blood pressure 134.2 [20.6], diastolic blood pressure 72.7 [11.2]mm Hg, total cholesterol 4.0 [0.9]mmol/L. Socioeconomic disadvantage was strongly related to measures of integration and attitude to diabetes. Despite this there were no significant or consistent relationships between Income Deprivation Measure/self-reported annual household income/educational attainment on metabolic or cardiovascular risk factors. Conclusions Successful management of modifiable risk factors can be achieved in a way that is independent of socioeconomic position.

Impact of socioeconomic deprivation and type of facility on perceptions of the Scottish smoke-free legislation

Impact of socioeconomic deprivation and type of facility on perceptions of the Scottish smoke-free legislation

Impact of Socio-Economic Deprivation on Mortality Rates after Upper GI Cancer Surgery

Aims: Mortality after oesophagectomy and gastrectomy for cancer varies widely between UK centres. We hypothesized that deprivation adversely affects mortality following upper GI cancer surgery.

Impact of socio-economic deprivation on death rates after surgery for upper gastrointestinal tract cancer

We hypothesised that socio-economic deprivation in England may be a prognostic factor for death after oesophagectomy or gastrectomy for cancer of the upper gastrointestinal tract. We analysed statistical data from hospital records linked to death records for patients who underwent operations for oesophageal and gastric cancer in England from April 1998 to March 2002. The patients were stratified into quintiles according to the index of multiple deprivation (IMD) (2000) for their place (ward) of residence. Age and sex standardised death rates at 30 and 90 days for each deprivation quintile were calculated. Following oesophagectomy, death rates showed a significant association with IMD. They increased with increasing levels of deprivation: the odds ratio for death, comparing highest with lowest quintile for deprivation, was 1.37 (95% confidence interval 1.03–1.85) at 30 days and 1.30 (1.04–1.64) at 90 days. Following gastrectomy, the death rates showed smaller and nonsignificant associations with IMD with odds ratios of 1.16 (0.84–1.62) and 1.10 (0.86–1.41), respectively. There is a significant association between social deprivation and death after oesophagectomy, but less of an association, if any, after gastrectomy in current UK practice.

Impact of socioeconomic deprivation on outcome after surgery for colorectal cancer.

Previous studies have demonstrated that socioeconomic deprivation is associated with poorer survival in patients with colorectal cancer. These differences have been attributed to more advanced disease at presentation. A total of 2269 patients undergoing resection for colorectal cancer in hospitals in central Scotland between 1991 and 1994 were studied. Socioeconomic status was defined using the Carstairs deprivation index. The impact of deprivation on case mix, treatment and outcome was analysed. There were no significant differences in mode of presentation, extent of disease at presentation, type of resection and postoperative mortality rate among the socioeconomic groups. Following curative resection, the overall survival rate at 5 years was 47.0 per cent in deprived patients, compared with 55.4 per cent in affluent patients (P = 0.05); the cancer-specific survival rate was 62.6 per cent in the deprived and 68.1 per cent in the affluent (P = 0.05). Compared with the affluent, the adjusted hazard ratios for the deprived were 1.36 (95 per cent confidence interval (c.i.) 1.09 to 1.69) for overall mortality and 1.26 (95 per cent c.i. 0.95 to 1.67) for cancer-specific mortality. Following palliative resection, there was no difference in survival between the affluent and deprived for either overall (P = 0.27) or cancer-specific (P = 0.89) mortality. These findings confirm that the cancer-specific survival rate following surgery for colorectal cancer is lower in deprived patients. Stage of disease at presentation and type of operation did not account for this difference. The excess mortality was confined to patients undergoing apparently curative resection.