Highlights
- •Similar associations were observed for postoperative complications, extended length of stay, and 30-day readmission.
- •Black beneficiaries had a persistently higher risk of post-operative mortality across upward economic mobility quintile, except within the highest upward mobility group.
Abstract
Background
While disadvantaged neighborhoods may be associated with worse outcomes and earlier
death, the relationship between economic opportunity and surgical outcomes remains
unexplored.
Methods
Medicare beneficiaries who underwent AAA, CABG, colectomy or cholecystectomy were
identified and stratified into quintiles based on upward economic mobility. Risk-adjusted
probability of adverse postoperative outcomes were examined relative to economic mobility.
Results
Among 1,081,745 Medicare beneficiaries (age: 75.5 years, female: 43.0%, White: 91.3%),
risk-adjusted 30-day postoperative mortality decreased in a stepwise fashion from
6.0%(5.9–6.1) in the lowest quintile of upward economic mobility to 5.3%(5.2–5.4)
in highest upward economic mobility (lowest vs. highest economic mobilityobility OR:1.14
(95%CI:1.11–1.17)). Similar associations were noted for postoperative complications
(OR:1.04, 95%CI:1.02–1.06), extended length-of-stay (OR:1.07, 95%CI:1.06–1.09), and
30-day readmission (OR:1.04, 95%CI:1.02–1.05). Black beneficiaries had a higher risk
of post-operative mortality across upward economic mobility quintiles except within
the highest upward mobility group (referent, White patients, OR:0.93, 95%CI:0.79–1.09,
p=0.355).
Conclusion
Economic upward mobility was associated with post-operative outcomes. Race-based differences
were mitigated at the highest levels of upward economic mobility, highlighting the
importance of socioeconomics as a health equity lever.
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Article info
Publication history
Published online: October 19, 2022
Accepted:
October 8,
2022
Received in revised form:
September 23,
2022
Received:
May 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
