The impact of social vulnerability subthemes on postoperative outcomes differs by racial/ethnic minority status - 10/02/22
, J. Madison Hyer a, 1, Diamantis Tsilimigras a, Timothy M. Pawlik aAbstract |
Introduction |
Social vulnerability is an important driver of disparate surgical outcomes, however the extent to which certain types of vulnerability impact outcomes is poorly understood.
Methods |
Medicare beneficiaries 65 years or older who underwent one of four operations were identified. Multivariable mixed-effects logistic regression was used to measure the association of four social vulnerability subthemes from the social vulnerability index (SVI) were assessed relative to the likelihood to achieve a textbook outcome (TO).
Results |
Among 579,846 Medicare beneficiaries, median age was 74 years and most patients (536,455,92.5%) were White/non-Hispanic. On multivariable analysis, the overall impact of the composite SVI metric on the odds to achieve a postoperative TO was lower among White/non-Hispanic patients (Δ25%ile SVI:OR:0.98,95%CI:0.97–0.98) compared with ethnic/minority patients (Δ25%ile SVI:OR:0.93,95%CI:0.91–0.94). Increasing vulnerability in the subthemes of socioeconomic status (Δ25%ile SVI:ethnic/minority:OR:0.92, 95%CI:0.91–0.94) and household composition (Δ25%ile SVI:ethnic/minority:OR:0.92,95%CI:0.91–0.94) was associated with a greater likelihood not to achieve a TO among minority patients.
Conclusions |
Worsening SES and household compositions & disability had a detrimental effect on odds of TO following surgery with the most pronounced effect on non-White minority patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The overall impact of SVI on odds to achieve a textbook outcome (TO) was lower among White/non-Hispanic patients compared with non-white patients. |
• | Increasing vulnerability in socioeconomic status and household composition was associated with a greater likelihood not to achieve a TO. |
• | Patients from areas of high socioeconomic and high household composition & disability vulnerability had much lower odds to achieve a TO. |
Keywords : Social determents of health, Textbook outcomes
Plan
Vol 223 - N° 2
P. 353-359 - février 2022 Retour au numéro
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