Madigan Claire D, Prentis James, Kunonga Edward, Snowden Chris, Fong Mackenzie, Brady Sophia Margarita, Gaffney Bob, Kaner Eileen F S
Loughborough University, Loughborough, UK
Department of Perioperative and Critical Care Medicine, Newcastle upon Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
BMJ Open. 2025 Mar 18;15(3):e097440. doi: 10.1136/bmjopen-2024-097440.
We examined the association of risk factors with socioeconomic deprivation in patients waiting for high volume low complexity (HVLC) surgical procedures in the North East and North Cumbria region.
We analysed data from the Rapid Actionable Insight Driving Reform database which links primary and secondary care elective waiting list data.
Patients were included if they were waiting for HVLC surgery or an initial outpatient appointment for HVLC surgery.
Smoking status, living with obesity, type 2 diabetes mellitus (T2DM), atrial fibrillation, chronic obstructive pulmonary disease (COPD), hypertension, serious mental illness or learning disability. Differences in outcomes by the England Index of Multiple Deprivation score quintiles were examined using ORs (95% CI).
Of 78 571 patients, 30.6% were living in the most deprived quintile, 29.4% were living with obesity, 28.9% had hypertension and 13.5% were smokers. Though younger, 64.2% of patients in the most deprived quintile had at least one risk factor compared with 48% of patients in the least deprived quintile (OR 1.9 (95% CI 1.9, 2.0). The odds of being a smoker, living with obesity, T2DM, COPD and a serious mental illness or learning disability decreased as deprivation decreased in a dose-response relationship.
People waiting for surgery from areas of greater deprivation are living with significantly more risk factors, and this may impact eligibility for surgery and surgical outcomes. Perioperative service provision must be delivered with deprivation in mind, otherwise health inequalities will be amplified.
我们研究了东北部和北坎布里亚地区等待高容量低复杂性(HVLC)外科手术患者的风险因素与社会经济剥夺之间的关联。
我们分析了来自快速可操作洞察驱动改革数据库的数据,该数据库将初级和二级医疗择期等待名单数据相链接。
等待HVLC手术或HVLC手术初次门诊预约的患者被纳入研究。
吸烟状况、肥胖、2型糖尿病(T2DM)、心房颤动、慢性阻塞性肺疾病(COPD)、高血压、严重精神疾病或学习障碍。使用比值比(OR)(95%置信区间)检验英格兰多重剥夺指数得分五分位数在结果方面的差异。
在78571名患者中,30.6%生活在最贫困的五分位数区域,29.4%患有肥胖症,28.9%患有高血压,13.5%为吸烟者。尽管最贫困五分位数区域的患者更年轻,但其中64.2%至少有一种风险因素,而最不贫困五分位数区域的患者这一比例为48%(OR 1.9(95% CI 1.9,2.0))。随着剥夺程度降低,吸烟、肥胖、T2DM、COPD以及严重精神疾病或学习障碍的患病几率呈剂量反应关系下降。
来自贫困程度较高地区的等待手术患者存在明显更多的风险因素,这可能会影响手术资格和手术结果。围手术期服务的提供必须考虑到剥夺因素,否则健康不平等将加剧。