Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease
Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease
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DOI：
10.1016/j.ejvs.2015.07.006
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发表时间：
2015-11-01
影响因子：
5.7
通讯作者：
Verhagen, H. J. M.
中科院分区：
文献类型：
--
作者：
Ultee, K. H. J.;Bastos Goncalves, F.;Verhagen, H. J. M.
目的/背景：血管手术后的社会经济状况(SES)、临床表现和预后之间的关系在很大程度上是未知的。这项研究的目的是在荷兰平等获得和提供护理的环境下，确定SES对血管外科患者术后生存率和疾病严重程度的影响。方法：对2003年1月至2011年12月期间因外周动脉疾病(PAD)、腹主动脉瘤(AAA)或颈动脉狭窄而接受手术治疗的患者进行回顾性研究。结果：共纳入1178名患者，采用Logistic和Cox回归分析方法，对人口统计学因素、医疗和行为危险因素进行了调整，研究了家庭收入、疾病严重程度和存活率与SES之间的关系。低收入与PAD队列(n=324，风险比1.05，95%可信区间[CI]1.00-1.10，每5,000欧元下降)和AAA队列(n=440，二次关系，p=.01)术后存活率较差有关。收入最低四分位数的AAA患者更有可能出现动脉瘤破裂(优势比[OR]2.12，95%可信区间1.08-4.17)。收入最低的四分位数PAD患者出现严重肢体缺血症状的频率更高，尽管没有建立显著的关联(OR 2.02，95%CI 0.96-4.26)。结论：考虑到研究环境提供的护理的平等性，本研究观察到的健康风险增加是由患者相关因素而不是医疗保健差异引起的。尽管SES与不良预后之间的确切机制尚不清楚，但将SES作为术前决策的危险因素，并专注于已知的SES相关行为和心理社会危险因素的治疗，可能会改善血管疾病患者的预后。(C)2015年欧洲血管外科学会。爱思唯尔有限公司出版。保留所有权利。
Objective/Background: The association between socioeconomic status (SES), presentation, and outcome after vascular surgery is largely unknown. This study aimed to determine the influence of SES on post-operative survival and severity of disease at presentation among vascular surgery patients in the Dutch setting of equal access to and provision of care.Methods: Patients undergoing surgical treatment for peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), or carotid artery stenosis between January 2003 and December 2011 were retrospectively included. The association between SES, quantified by household income, disease severity at presentation, and survival was studied using logistic and Cox regression analysis adjusted for demographics, and medical and behavioral risk factors.Results: A total of 1,178 patients were included. Low income was associated with worse post-operative survival in the PAD cohort (n = 324, hazard ratio 1.05, 95% confidence interval [Cl] 1.00-1.10, per 5,000 Euro decrease) and the AAA cohort (n = 440, quadratic relation, p = .01). AAA patients in the lowest income quartile were more likely to present with a ruptured aneurysm (odds ratio [OR] 2.12, 95% Cl 1.08-4.17). Lowest income quartile PAD patients presented more frequently with symptoms of critical limb ischemia, although no significant association could be established (OR 2.02, 95% Cl 0.96-4.26).Conclusions: The increased health hazards observed in this study are caused by patient related factors rather than differences in medical care, considering the equality of care provided by the study setting. Although the exact mechanism driving the association between SES and worse outcome remains elusive, consideration of SES as a risk factor in pre-operative decision making and focus on treatment of known SES related behavioral and psychosocial risk factors may improve the outcome of patients with vascular disease. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.