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Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years.

Pagano D, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, Keogh BE, Quality and Outcomes Research Unit (QuORU) UHB BirminghamNorth West Quality Improvement Programme in Cardiac Interventions (UKNWQI - BMJ (2009)

Bottom Line: Prognostic models used to examine the additional effect of social deprivation on the end points.The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001).Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Cardiothoracic Surgical Unit, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH. domenico.pagano@uhb.nhs.uk

ABSTRACT

Objective: To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors.

Design: Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points.

Setting: Birmingham and north west England.

Participants: 44 902 adults undergoing cardiac surgery, 1997-2007.

Main outcome measures: Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up.

Results: In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001).

Conclusions: Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.

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Fig 2 Percentage increase in hazard of death during mid-term follow-up. Carstairs 1: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are not included in model. Carstairs 2: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are included in model
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fig2: Fig 2 Percentage increase in hazard of death during mid-term follow-up. Carstairs 1: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are not included in model. Carstairs 2: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are included in model

Mentions: The inclusion of BMI, diabetes, and smoking in the multivariable model for mid-term survival led to a reduction in the risk of mortality because of social deprivation from 2.4% to 1.7% for each point increment in Carstairs score, resulting in an overall reduction in mortality of 29%. In this model, diabetes carried a 31% increased risk and smoking a 29% increased risk of death (table 3, fig 2). Figure 3 shows the non-linear effects of varying BMI on the risk of mid-term mortality, where lower and higher BMI both carry increased risk, with approximate 95% confidence intervals. There were no first order statistical interactions between the Carstairs score and the other included patient level covariates.


Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years.

Pagano D, Freemantle N, Bridgewater B, Howell N, Ray D, Jackson M, Fabri BM, Au J, Keenan D, Kirkup B, Keogh BE, Quality and Outcomes Research Unit (QuORU) UHB BirminghamNorth West Quality Improvement Programme in Cardiac Interventions (UKNWQI - BMJ (2009)

Fig 2 Percentage increase in hazard of death during mid-term follow-up. Carstairs 1: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are not included in model. Carstairs 2: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are included in model
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2664869&req=5

fig2: Fig 2 Percentage increase in hazard of death during mid-term follow-up. Carstairs 1: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are not included in model. Carstairs 2: increased risk for 5 point increment in Carstairs score when diabetes, smoking, and BMI are included in model
Mentions: The inclusion of BMI, diabetes, and smoking in the multivariable model for mid-term survival led to a reduction in the risk of mortality because of social deprivation from 2.4% to 1.7% for each point increment in Carstairs score, resulting in an overall reduction in mortality of 29%. In this model, diabetes carried a 31% increased risk and smoking a 29% increased risk of death (table 3, fig 2). Figure 3 shows the non-linear effects of varying BMI on the risk of mid-term mortality, where lower and higher BMI both carry increased risk, with approximate 95% confidence intervals. There were no first order statistical interactions between the Carstairs score and the other included patient level covariates.

Bottom Line: Prognostic models used to examine the additional effect of social deprivation on the end points.The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001).Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001).

View Article: PubMed Central - PubMed

Affiliation: Cardiothoracic Surgical Unit, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH. domenico.pagano@uhb.nhs.uk

ABSTRACT

Objective: To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors.

Design: Analysis of prospectively collected data. Prognostic models used to examine the additional effect of social deprivation on the end points.

Setting: Birmingham and north west England.

Participants: 44 902 adults undergoing cardiac surgery, 1997-2007.

Main outcome measures: Social deprivation with census based 2001 Carstairs scores. All cause mortality in hospital and at mid-term follow-up.

Results: In hospital mortality for all cardiac procedures was 3.25% and mid-term follow-up (median 1887 days; range 1180-2725 days) mortality was 12.4%. Multivariable analysis identified social deprivation as an independent predictor of mid-term mortality (hazard ratio 1.024, 95% confidence interval 1.015 to 1.033; P<0.001). Smoking (P<0.001), body mass index (BMI, P<0.001), and diabetes (P<0.001) were associated with social deprivation. Smoking at time of surgery (1.294, 1.191 to 1.407, P<0.001) and diabetes (1.305, 1.217 to 1.399, P<0.001) were independent predictors of mid-term mortality. The relation between BMI and mid-term mortality was non-linear and risks were higher in the extremes of BMI (P<0.001). Adjustment for smoking, BMI, and diabetes reduced but did not eliminate the effects of social deprivation on mid-term mortality (1.017, 1.007 to 1.026, P<0.001).

Conclusions: Smoking, extremes of BMI, and diabetes, which are potentially modifiable risk factors associated with social deprivation, are responsible for a significant reduction in survival after surgery, but even after adjustment for these variables social deprivation remains a significant independent predictor of increased risk of mortality.

Show MeSH
Related in: MedlinePlus