scholarly journals Low Socioeconomic Status Is Associated With Increased Complication Rates: Are Risk Adjustment Models Necessary in Cervical Spine Surgery?

2019 ◽  
Vol 10 (6) ◽  
pp. 748-753 ◽  
Author(s):  
Alexander M. Lieber ◽  
Anthony J. Boniello ◽  
Yehuda E. Kerbel ◽  
Philip Petrucelli ◽  
Venkat Kavuri ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Risk Adjustment ◽  
Hospital Costs ◽  
Income Group ◽  
Complication Rates ◽  
Cervical Spine Surgery ◽  
Spine Care ◽  
Anterior Discectomy And Fusion ◽  
Income Quartile

Study Design: Retrospective cohort study. Objectives: The objective of this study was to determine whether lower socioeconomic status was associated with increased resource utilization following anterior discectomy and fusion (ACDF). Methods: The National Inpatient Sample database was queried for patients who underwent a primary, 1- to 2-level ACDF between 2005 and 2014. Trauma, malignancy, infection, and revision surgery were excluded. The top and bottom income quartiles were compared. Demographics, medical comorbidities, length of stay, complications, and hospital cost were compared between patients of top and bottom income quartiles. Results: A total of 69 844 cases were included. The bottom income quartile had a similar mean hospital stay (2.04 vs 1.77 days, P = .412), more complications (2.45% vs 1.77%, P < .001), and a higher mortality rate (0.18% vs 0.11%, P = .016). Multivariate analysis revealed bottom income quartile was an independent risk factor for complications (odds ratio = 1.135, confidence interval = 1.02-1.26). Interestingly, the bottom income quartile experienced lower mean hospital costs ($17 041 vs $17 958, P < .001). Conclusion: Patients in the lowest income group experienced more complications even after adjusting for comorbidities. Therefore, risk adjustment models, including socioeconomic status, may be necessary to avoid potential problems with access to orthopedic spine care for this patient population.

Higher complication rates after management of lower extremity fractures in lower socioeconomic classes: Are risk adjustment models necessary?

Trauma ◽  
2020 ◽  
pp. 146040862097569
Author(s):  
Jeffrey M Henstenburg ◽  
Alexander M Lieber ◽  
Anthony J Boniello ◽  
Yehuda E Kerbel ◽  
Mitesh Shah
Keyword(s):  
Socioeconomic Status ◽  
Length Of Stay ◽  
Lower Extremity ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Risk Adjustment ◽  
Complication Rates ◽  
Lower Socioeconomic Status ◽  
Lower Socioeconomic ◽  
Income Quartile

Introduction Alternative payment models, such as bundled payments, have been proposed to control rising costs in orthopaedic trauma surgery. Without risk adjustment models, concerns exist about the financial burden incurred by so called “safety-net hospitals” that serve patients of lower socioeconomic status. The purpose of this study was to determine whether lower socioeconomic status was associated with increased complications and subsequently higher resource utilization following surgical treatment of high-energy lower extremity fractures. Methods The National Inpatient Sample database was queried for patients who underwent surgical fixation of the femur and tibia between 2005–2014. The top and bottom income quartiles were compared. Demographics, medical comorbidities, length of stay (LOS), complications, in-hospital mortality were compared between patients of top and bottom income quartiles. Multivariate logistic regression analysis was then performed to identify factors independently associated with complications, mortality, and increased resource utilization. Results Patients with femur fracture in the bottom income quartile had longer length of stay (6.9 days vs 6.5 days, p < 0.001) and a higher mortality rate (1.9% vs 1.7%, p = 0.034). Patients with tibia fracture in the bottom income quartile had greater complication rates (7.3% vs 6.1%, p < 0.001), longer length of stay (5.3 days vs. 4.5 days, p < 0.001), and higher mortality (0.3% vs. 0.2%, p < 0.001). Conclusions Lower income status is associated with increased in-hospital mortality and longer length of stay in patients following lower extremity fractures. Risk adjustment models should consider the role of socioeconomic status in patient resource utilization to ensure continued access to orthopedic trauma care for all patients.

scholarly journals Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

2017 ◽  
Vol 33 (10) ◽  
pp. 551-556 ◽  
Author(s):  
Barret Rush ◽  
Katie Wiskar ◽  
Leo Anthony Celi ◽  
Keith R. Walley ◽  
James A. Russell ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Hospital Mortality ◽  
Low Socioeconomic Status ◽  
Household Income ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
The United States ◽  
Median Income ◽  
Risk Of Mortality ◽  
Income Quartile

Objective: Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States. Methods: Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed. Results: A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99-1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97-1.01, P = .40) quartiles compared to the highest. Conclusion: After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES.

scholarly journals Clinical and Economic Outcomes of Thyroid and Parathyroid Surgery in Children

2008 ◽  
Vol 93 (8) ◽  
pp. 3058-3065 ◽  
Author(s):  
Julie Ann Sosa ◽  
Charles T. Tuggle ◽  
Tracy S. Wang ◽  
Daniel C. Thomas ◽  
Leon Boudourakis ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Low Income ◽  
Hospital Costs ◽  
High Volume ◽  
Income Group ◽  
Economic Outcomes ◽  
Complication Rates ◽  
Cross Sectional ◽  
Specific Complication ◽  
Low Income Families

Abstract Context: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes. Objective: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy. Design: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project–National Inpatient Sample hospital discharge information from 1999–2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes. Subjects: Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy. Main Outcome Measures: Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs. Results: The majority of patients were female (76%), aged 13–17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P &lt; 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P &lt; 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P &lt; 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0–6 yr had higher complication rates (22% vs. 15% for 7–12 yr and 11% for 13–17 yr; P &lt; 0.01), LOS (3.3 d vs. 2.3 for 7–12 yr and 1.8 for 13–17 yr; P &lt; 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P &lt; 0.05), longer LOS (2.7 vs. 1.7 d; P &lt; 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P &lt; 0.01) and thyroidectomy (9.1 vs. 6.3%; P &lt; 0.01). Conclusions: Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.

Abstract 13852: Socioeconomic Status is Associated With Recurrent Cardiovascular Disease Events in People With Prevalent Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lena Mathews ◽  
Ning Ding ◽  
Yejin Mok ◽  
Matthew S Loop ◽  
Amira Collison ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Total Mortality ◽  
Income Group ◽  
High Risk Group ◽  
Area Deprivation ◽  
Established Risk Factor ◽  
Increased Risk

Introduction: While low socioeconomic status (SES) is an established risk factor for incident cardiovascular disease (CVD), there is scarce data regarding the association between SES and recurrent CVD events. Hypothesis: SES measures are associated with recurrent CVD events and mortality among those with prevalent CVD. Methods: We examined 3,031 individuals in the ARIC Study who developed CVD (either myocardial infarction [MI], heart failure [HF] or stroke) from the baseline visit (1987-1989) through 2013 to allow 5 years follow-up for recurrent CVD. SES was defined using baseline measures of income, education and area deprivation index (ADI), modeled individually and combined in a cumulative SES score. We used adjusted Cox proportional hazard regression to evaluate the associations of SES with composite and individual outcomes of first recurrent CVD and mortality. Results: Median age was 69 years, 49% were female, 29% Black. Over a median follow up of 4.6 years, 2,033 participants (67%) had a recurrent CVD event, and 2,202 (73%) died. Relative to the highest income group, being in the lowest income group was associated with higher risk for recurrent CVD (HR 1.27; 95% CI: 1.07-1.51) and mortality (HR 1.32; 95% CI: 1.12-1.56) ( Table ). Similarly, less than high school education was associated with increased risk of recurrent CVD (HR 1.25; 95% CI: 1.04-1.51) and mortality (HR 1.21; 95% CI: 1.01-1.45). No significant outcome associations were seen for ADI. Low cumulative SES was associated with approximately 20% higher risk of recurrent CVD, total mortality and the composite of recurrent CVD and mortality. Similar patterns were seen for individual subtypes of CVD, with the strongest SES-mortality associations for MI and stroke. Conclusions: In the high-risk group of individuals with existing CVD, low SES was linked to greater likelihood of recurrent CVD events and death. SES should be a focus in the design of secondary prevention efforts to improve outcomes in CVD.

Tomorrow never knows: Paradoxical effects of a future prime on performance among low socioeconomic status college students

2014 ◽  
Author(s):  
Sarah Dayle Herrmann ◽  
Jessica Bodford ◽  
Robert Adelman ◽  
Oliver Graudejus ◽  
Morris Okun ◽  
...  
Keyword(s):  
College Students ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Low Socioeconomic ◽  
Paradoxical Effects

scholarly journals Home Language and Literacy Environments and Early Literacy Trajectories of Low‐Socioeconomic Status Chilean Children

2020 ◽  
Vol 91 (6) ◽  
pp. 2042-2062
Author(s):  
Susana Mendive ◽  
Mayra Mascareño Lara ◽  
Daniela Aldoney ◽  
J. Carola Pérez ◽  
José P. Pezoa
Keyword(s):  
Socioeconomic Status ◽  
Early Literacy ◽  
Low Socioeconomic Status ◽  
Home Language ◽  
Language And Literacy ◽  
Low Socioeconomic ◽  
Literacy Environments

scholarly journals Association of socioeconomic status with medical assistance in dying: a case–control analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043547
Author(s):  
Donald A Redelmeier ◽  
Kelvin Ng ◽  
Deva Thiruchelvam ◽  
Eldar Shafir
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Case Control ◽  
Control Analysis ◽  
Medical Assistance ◽  
Low Socioeconomic ◽  
Medical Assistance In Dying ◽  
Income Status ◽  
Economic Constraints

ObjectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.DesignPopulation-based case–control study of adults who died.SettingOntario, Canada, between 1 June 2016 and 1 June 2019.PatientsPatients receiving palliative care under universal insurance with no user fees.ExposurePatient’s socioeconomic status identified using standardised quintiles.Main outcome measureWhether the patient received medical assistance in dying.ResultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.ConclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.

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