The Association of Socioeconomic Factors With Percutaneous Coronary Intervention Outcomes

Background Numerous studies have identified the association of socio-economic factors with outcomes of cardiac surgical procedures. Most have focused on easily measured demographic factors or on socio-economic characteristics of patients’ 5-digit zip codes. The impact of socio-economic information that is derived from smaller geographic regions has rarely been studied. Methods The association of the Area Deprivation Index (ADI) with short-term mortality and readmissions was tested for patients undergoing percutaneous coronary intervention (PCI) in New York while adjusting for numerous patient risk factors, including race, ethnicity, and payer. Changes in hospitals’ risk-adjusted outcomes and outlier status with the addition of socio-economic factors were examined. Results After adjustment, patients in the two most deprived ADI quintiles were more likely to experience in-hospital/30-day mortality following PCI (AOR = 1.39 (1.18, 1.65) and AOR = 1.24 (1.03, 1.49)), respectively, than patients in the first quintile (least deprived). Also, patients in the second (1.12 (1.01, 1.25)) and fifth (1.17 (1.04, 1.32)) ADI quintiles had higher 30-day readmissions rates than patients in the first quintile. Medicare patients had higher mortality and readmission rates, Hispanics had lower mortality, and Medicaid patients had higher readmission rates. Conclusions Patients with the most deprived ADIs are more likely to experience short-term mortality and readmissions following PCI. Ethnicity and payer are significantly associated with adverse outcomes even while adjusting for ADI. This information should be considered when identifying patients who are at the highest risk for adverse events following PCI, and when risk-adjusting hospital outcomes and assessing quality of care.