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In their paper, “Socioeconomic status and early outcome from coronary artery bypass grafting” (see article on page 793), Gibson and his colleagues from Aberdeen have clearly shown that socio-economic deprivation is associated with poorer outcomes from coronary artery bypass grafting (CABG).1 In a study of patients who underwent CABG from April 2000 to March 2004, they showed that patients in the quartile with the highest deprivation scores had a significantly higher chance of dying following CABG than those from the least deprived areas, and that this is independent of other conventionally assessed risk factors (odds ratio 2.56 adjusted for EuroSCORE; CI 1.03 to 6.34; p = 0.04). In addition, patients in the least affluent quartile were twice as likely to suffer a major, non-fatal complication.
Should we be surprised by these findings? No, we should not, but we should be concerned. There are many potential reasons for this difference, ranging from higher smoking rates and poorer nutritional status to worse housing conditions, all of which play a part in a patient’s ability to recover from major surgery.
There is a wealth of evidence that deprivation is associated with an increased incidence of cardiovascular disease and its complications. The Health Survey for England, 20032 showed this positive association between deprivation and increased prevalence of coronary artery disease, and several studies have shown that the most deprived patients have the poorest outcomes. A study from Bristol3 published in this journal in 2003 showed not only that patients from the most deprived areas suffered more complications from CABG but that their long-term survival was also worse (though interestingly, in this study, their operative mortality was …