Social Inequality in Heart Surgery and General Health
People living in more deprived areas have a higher risk of death after heart surgery, experts have found. Dr. Domenico Pagano, of Queen Elizabeth Hospital, Birmingham, UK, and colleagues carried out a recent study into modifiable risk factors for death after cardiac surgery.
On the website of the British Medical Journal, they explain that social inequalities are known to increase overall mortality. “The link between poverty, socioeconomic inequalities, and increased mortality is well established,” they write, “but the extent to which such inequalities can be modified is unknown.”
They carried out the study because cardiovascular disease is the top cause of premature death in the Western world, and is also “closely related to socioeconomic deprivation.” Heart surgery encompasses many beneficial procedures, and the team investigated whether the benefits apply across all socioeconomic levels.
They analyzed figures on 44,902 adults undergoing cardiac surgery between January 1997 and December 2007. Social deprivation scores were derived from levels of unemployment, car ownership, overcrowding, and low occupational social class in the patient’s neighborhood.
Social deprivation was significantly linked to risk of death in hospital. Surviving patients were followed for approximately five years, during which 12 percent died. Again, social deprivation was linked to reduced long-term survival.
The extra risk was partly accounted for by smoking, body mass index, and diabetes. But when these were taken into account, deprivation remained a strong predictor of increased risk. The researchers say this suggests that some other factors related to deprivation are having a negative effect on survival.
The team writes, “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. We have identified some important modifiable clinical factors (smoking, body mass index and diabetes) that if addressed might substantially reduce the adverse effects of social deprivation on survival after cardiac surgery.”
However, they add, “The influence of social deprivation on survival remained predictive, indicating that some additional factors related to deprivation might influence outcome.” They believe that the risk could be lowered by better targeting of resources and education on how to engage with healthcare services.