Ultee K H J, Bastos Gonçalves F, Hoeks S E, Rouwet E V, Boersma E, Stolker R J, Verhagen H J M
Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands.
Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Eur J Vasc Endovasc Surg. 2015 Nov;50(5):615-22. doi: 10.1016/j.ejvs.2015.07.006. Epub 2015 Aug 10.
OBJECTIVE/BACKGROUND: The association between socioeconomic status (SES), presentation, and outcome after vascular surgery is largely unknown. This study aimed to determine the influence of SES on post-operative survival and severity of disease at presentation among vascular surgery patients in the Dutch setting of equal access to and provision of care.
Patients undergoing surgical treatment for peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), or carotid artery stenosis between January 2003 and December 2011 were retrospectively included. The association between SES, quantified by household income, disease severity at presentation, and survival was studied using logistic and Cox regression analysis adjusted for demographics, and medical and behavioral risk factors.
A total of 1,178 patients were included. Low income was associated with worse post-operative survival in the PAD cohort (n = 324, hazard ratio 1.05, 95% confidence interval [CI] 1.00-1.10, per 5,000 Euro decrease) and the AAA cohort (n = 440, quadratic relation, p = .01). AAA patients in the lowest income quartile were more likely to present with a ruptured aneurysm (odds ratio [OR] 2.12, 95% CI 1.08-4.17). Lowest income quartile PAD patients presented more frequently with symptoms of critical limb ischemia, although no significant association could be established (OR 2.02, 95% CI 0.96-4.26).
The increased health hazards observed in this study are caused by patient related factors rather than differences in medical care, considering the equality of care provided by the study setting. Although the exact mechanism driving the association between SES and worse outcome remains elusive, consideration of SES as a risk factor in pre-operative decision making and focus on treatment of known SES related behavioral and psychosocial risk factors may improve the outcome of patients with vascular disease.
目的/背景：社会经济地位（SES）与血管手术后的表现及预后之间的关联在很大程度上尚不清楚。本研究旨在确定在荷兰平等获得医疗服务的背景下，SES对血管外科患者术后生存率及疾病严重程度的影响。
回顾性纳入2003年1月至2011年12月期间接受外周动脉疾病（PAD）、腹主动脉瘤（AAA）或颈动脉狭窄手术治疗的患者。采用逻辑回归和Cox回归分析，对人口统计学、医疗和行为风险因素进行调整，研究SES（以家庭收入量化）、就诊时疾病严重程度与生存率之间的关联。
共纳入1178例患者。低收入与PAD队列（n = 324，风险比1.05，95%置信区间[CI] 1.00 - 1.10，每减少5000欧元）和AAA队列（n = 440，二次关系，p = 0.01）中较差的术后生存率相关。收入最低四分位数的AAA患者更有可能出现动脉瘤破裂（优势比[OR] 2.12，95% CI 1.08 - 4.17）。收入最低四分位数的PAD患者更频繁地出现严重肢体缺血症状，尽管未发现显著关联（OR 2.02，95% CI 0.96 - 4.26）。
考虑到研究环境中提供的医疗服务平等性，本研究中观察到的健康危害增加是由患者相关因素而非医疗差异导致的。尽管SES与较差预后之间关联的确切机制仍不明确，但在术前决策中考虑SES作为风险因素，并关注已知的与SES相关的行为和心理社会风险因素的治疗，可能会改善血管疾病患者的预后。
