Chan Jeremy, Narayan Pradeep, Law Jacie Jiaqi, Dong Tim, Angelini Gianni D
Bristol Heart Institute, University of Bristol, Bristol, UK.
Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, West Bengal, India.
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6). doi: 10.1093/icvts/ivaf119.
Previous studies have identified a correlation between socioeconomic deprivation and poorer outcomes following cardiac surgery in the USA, where healthcare is predominantly delivered through private system. However, the influence of socioeconomic deprivation in countries with universal healthcare systems, such as the UK, has been less extensively investigated. Therefore, we used the index of multiple deprivation (IMD) to evaluate the impact of socioeconomic status on early clinical outcomes following coronary artery bypass grafting (CABG) in the UK.
All patients who underwent elective/urgent isolated CABG between 2008 and 2019 in the UK were included. The IMD, along with other perioperative characteristics, were incorporated into a regression model to determine factors associated with in-hospital mortality.
The analysis included 182 911 patients (median age: 67.3 years, 82.13% male). Patients were categorized into five groups based on IMD, 1: most deprived to 5 the least: 1 = 30 564, 2 = 30 815, 3 = 59 161, 4 = 31 891 and 5 = 30 480. Patients from the most socioeconomically deprived areas exhibited markedly higher rates of comorbidities and risk factors such as diabetes and had a higher rate of urgent surgical intervention. There is a small increase in in-hospital mortality when socioeconomic status declined, with rates of 1.30, 1.30, 1.24, 1.14 and 1.15% for group 1-5, respectively. Socioeconomic deprivation, particularly in income and education, was associated with an increase in in-hospital survival.
Socioeconomic deprivation, particularly in income and education, is associated with higher burdens of comorbidity and a small decrease in-hospital survival after CABG in the UK. This suggests that these factors may play a critical role in clinical outcomes even in a universal healthcare system.
此前的研究已确定在美国，社会经济贫困与心脏手术后较差的预后之间存在关联，美国的医疗保健主要通过私人系统提供。然而，在英国等拥有全民医疗保健系统的国家，社会经济贫困的影响尚未得到广泛研究。因此，我们使用多重剥夺指数（IMD）来评估社会经济地位对英国冠状动脉旁路移植术（CABG）后早期临床结局的影响。
纳入2008年至2019年在英国接受择期/急诊单纯CABG的所有患者。将IMD以及其他围手术期特征纳入回归模型，以确定与住院死亡率相关的因素。
分析纳入了182911例患者（中位年龄：67.3岁，82.13%为男性）。根据IMD将患者分为五组，1：最贫困到5：最不贫困：1 = 30564例，2 = 30815例，3 = 59161例，4 = 31891例，5 = 30480例。来自社会经济最贫困地区的患者表现出明显更高的合并症和危险因素发生率，如糖尿病，并且紧急手术干预率更高。随着社会经济地位下降，住院死亡率略有上升，第1 - 5组的死亡率分别为1.30%、1.30%、1.24%、1.14%和1.15%。社会经济贫困，特别是在收入和教育方面，与住院生存率降低有关。
社会经济贫困，特别是在收入和教育方面，与更高的合并症负担以及英国CABG后住院生存率略有下降有关。这表明即使在全民医疗保健系统中，这些因素也可能在临床结局中起关键作用。
