Higher mortality risks for patients at hospitals serving low-income population

Low-income patients face higher operative mortality rates but not because of their socioeconomic standing. It's because of the hospital that treats them, according to a new study published in JAMA Surgery.

To try and better understand disparities in operative mortality, researchers from the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor examined 596,222 cases of patients that underwent esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection and cystectomy for cancer from 2003 to 2007, according to the study.

Researchers linked socioeconomic status to each zip code using 2000 U.S. Census data and compared data on operative mortality, postoperative complications and failure to rescue (FTR) rates. Lower-income patients' FTR rates increased the most (26.7 percent), compared to 23.2 percent among the highest income group, the study found. However, hospital analysis revealed a higher FTR rate for all patients, regardless of socioeconomic status, at facilities that treated the largest proportion of low-income patients.

Researchers also found that patients in the lowest socioeconomic quintile had a slightly increased risk (25.6 percent) of complications, compared to their counterparts in the highest quintile (23.8 percent). There was a larger increase in mortality--10.2 percent to 7.7 percent, respectively.

Hospital and staff attitude toward patient safety could be an underlying factor, senior study author Amir Ghaferi, M.D., told Reuters Health. "When it comes down to it, your surgical care doesn't happen within a silo," he said. "It happens within the greater system of a large or small hospital."

To learn more:
- here's the study
- read the article

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