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The Impact of Income on Emergency General Surgery Outcomes in Urban and Rural Areas
- Source :
- The Journal of surgical research. 245
- Publication Year :
- 2019
-
Abstract
- 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.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]).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).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.
- Subjects :
- Adult
Male
Rural Population
medicine.medical_specialty
Adolescent
Urban Population
Hospitals, Rural
Health Services Accessibility
Odds
03 medical and health sciences
Young Adult
0302 clinical medicine
Hospitals, Urban
Postoperative Complications
Health care
medicine
Humans
Hospital Mortality
Healthcare Disparities
Adverse effect
Socioeconomic status
Lower income
Emergency Treatment
Retrospective Studies
Inpatients
business.industry
General surgery
Middle Aged
United States
Quartile
Failure to Rescue, Health Care
030220 oncology & carcinogenesis
Surgical Procedures, Operative
Cohort
Income
030211 gastroenterology & hepatology
Surgery
Female
Rural area
business
Emergency Service, Hospital
Subjects
Details
- ISSN :
- 10958673
- Volume :
- 245
- Database :
- OpenAIRE
- Journal :
- The Journal of surgical research
- Accession number :
- edsair.doi.dedup.....de4bf0c43de505707c757ab455cc7a11