BMJ: Social demographics could determine cardiac surgery survival rates

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People from the most deprived areas of England have a far higher risk of death after cardiac surgery than people from the least deprived areas, according to a 10-year observational study of 44,902 patients from five hospitals published in BMJ.

The researchers set out to assess the effects of social deprivation on survival following a range of cardiac surgical procedures. They analyzed 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.

The investigators found that 3.25 percent of patients died in hospital following their surgery and 12.4 percent of patients died during five year follow-up.

Social deprivation was a strong independent predictor of death, according to the authors.

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 percent increased risk and smoking a 29 percent increased risk of death. Adjusting for these factors reduced 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. The study raises the concern that the effect of proven healthcare interventions, like cardiac surgery, may not be equally distributed across socioeconomic boundaries.

However, the authors concluded that the real challenge lies in developing a coherent health-conscious approach to education and to the environment, which is essential to maximizing the benefits of expensive and complex healthcare interventions such as cardiac surgery.

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

They pointed out that, under the quality and outcomes framework (QOF) - a system where general practitioners receive financial benefits on achieving specific targets - use of statins in socially deprived areas has increased significantly, and they suggest that this may help to narrow the health gap between rich and poor for coronary heart disease and other conditions.

But ultimately, decent education, adequate housing and adequate employment opportunities are what are needed to narrow the gap between the health of the rich and the poor, the editorial concluded.