Patient Socioeconomic Status Is an Independent Predictor of Operative Mortality
Patient Socioeconomic Status Is an Independent Predictor of Operative Mortality
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DOI：
10.1097/sla.0b013e3181f2ac64
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发表时间：
2010-09-01
影响因子：
9
通讯作者：
Kepler, Thomas B.
中科院分区：
文献类型：
--
作者：
Bennett, Kyla M.;Scarborough, John E.;Kepler, Thomas B.
目的：在相关因素的背景下评估患者社会经济状况(SES)对手术死亡率的影响。背景资料摘要：手术患者之间的结果差异是一个重要的问题。以前的研究表明，SES和结果之间的相关性可归因于其他患者或医院层面的解释因素，如种族或医院财富。这些研究通常集中在对这些不平等存在的单一解释上。方法：通过对100多万例全国住院患者样本的分析，我们使用多模型推理来评估社会经济预测因素对手术死亡率的影响。结果：单因素和多因素Logistic回归分析发现，患者的SES是手术死亡率的有力预测因素。多元回归包含了许多额外的医院和患者水平的协变量。患者SES每增加一个水平，手术死亡率风险平均降低7.1%。结论：患者个体水平的SE对手术死亡率有统计学意义的影响。死亡率最高的是最低社会经济阶层的患者。患者SES对死亡率的影响不能被其他解释的医院或患者水平的因素所减轻。
Objective: To evaluate the impact of patient socioeconomic status (SES) on operative mortality within the context of associated factors. Summary of Background Data: Outcomes disparities among surgical patients are a significant concern. Previous studies have suggested that the correlation between SES and outcomes is attributable to other patient-or hospital-level explanatory factors such as race or hospital wealth. These studies have typically focused on a single explanation for the existence of these inequalities. Methods: Analyzing more than 1 million records of the Nationwide Inpatient Sample, we used multimodel inference to evaluate the effects of socioeconomic predictors on surgical mortality. Results: Using univariate and multivariate logistic regression, we find that patient's SES is a strong predictor of operative mortality. Multivariate regressions incorporated many additional hospital-and patient-level covariates. A single-level increase in patient SES results in a mean decrease in operative mortality risk of 7.1%. Conclusions: SES at the level of the individual patient has a statistically significant effect on operative mortality. Mortality is greatest among patients in the lowest socioeconomic strata. The effect of patient SES on mortality is not mitigated by other explanatory hospital-or patient-level factors.