Back to Search Start Over

The Impact of Income on Emergency General Surgery Outcomes in Urban and Rural Areas.

Authors :
de Jager E
Chaudhary MA
Rahim F
Jarman MP
Uribe-Leitz T
Havens JM
Goralnick E
Schoenfeld AJ
Haider AH
Source :
The Journal of surgical research [J Surg Res] 2020 Jan; Vol. 245, pp. 629-635. Date of Electronic Publication: 2019 Sep 12.
Publication Year :
2020

Abstract

Background: Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions annually. Low-income EGS patients have higher rates of postoperative adverse events (AEs) than high-income patients. This may be related to health care segregation (a disparity in access to high-quality centers). The emergent nature of EGS conditions and the limited number of EGS providers in rural areas may result in less health care segregation and thereby less variability in EGS outcomes in rural areas. The objective of this study was to assess the impact of income on AEs for both rural and urban EGS patients.<br />Materials and Methods: The National Inpatient Sample (2007-2014) was queried for patients receiving one of 10 common EGS procedures. Multivariate regression models stratified by income quartiles in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based factors were used to determine the rates of surgical AEs (mortality, complications, and failure to rescue [FTR]).<br />Results: 1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52).<br />Conclusions: Lower income is associated with higher postoperative AEs in the urban setting but not in a rural environment. This socioeconomic disparity in EGS outcomes in urban settings may reflect health care segregation, a differential access to high-quality health care for low-income patients.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1095-8673
Volume :
245
Database :
MEDLINE
Journal :
The Journal of surgical research
Publication Type :
Academic Journal
Accession number :
31522036
Full Text :
https://doi.org/10.1016/j.jss.2019.08.010