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Poor patients more likely to die after heart surgery than rich

Social deprivation is a strong predictor of death, BMJ study finds

OnMedica Staff

Friday, 03 April 2009

Patients from poor areas have a higher risk of death after cardiac surgery than those from less deprived areas.

A large study published on bmj.com today, found social deprivation to be a strong independent predictor of death.

The researchers analysed data on 44,902 patients, with an average age of 65 years, who underwent cardiac surgery between 1997 and 2007 at five hospitals in Birmingham and North West England.

Social deprivation was calculated for all patients based on their postcode at the 2001 census for England and Wales.

A total of 1,461 patients (3.25%) died in hospital following their surgery and 5,563 patients (12.4%) died during five year follow-up.

Smoking, obesity and diabetes were all associated with social deprivation, and were each responsible for a significant reduction in survival following surgery. For example, diabetes carried a 31% increased risk and smoking a 29% increased risk of death.

Adjusting for these factors did reduce the impact, but deprivation remained a strong predictor of increased mortality risk, suggesting that some other factors related to deprivation are having this negative effect on survival.

In summary, people from deprived socioeconomic groups not only have a shorter life expectancy but also spend a greater proportion of their lives affected by disability or illness, say the authors.
This study raises the concern that the effect of proven healthcare interventions, like cardiac surgery, may not be equally distributed across socioeconomic boundaries.

The fact that socially deprived people are more likely to be obese, smoke, and have diabetes highlights the need to target rehabilitation processes at these patients after cardiac surgery, say two cardiac specialists at Edinburgh Royal Infirmary in an accompanying editorial.

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