Objective: To determine the effects of socioeconomic status (SES) on the outcome of coronary artery bypass grafting (CABG).
Design: Prospective cohort study.
Setting: Regional cardiac surgical unit.
Patients: One thousand nine hundred and ninety four consecutive patients undergoing non-emergency CABG.
Measures: SES was determined from the patient’s postcode using Carstairs tables. The primary end-point was all-cause mortality at 30-days.
Results: There were 50 deaths (2.5%) within 30-days of surgery. A higher Carstairs score demonstrated a trend towards increased 30-day mortality (odds ratio [OR] 1.09 per unit, 95% confidence interval [CI] 1.00-1.20, p=0.06). In a backward conditional model, including other predictors of early mortality, Carstairs scores were independently predictive (OR 1.12 per unit, 95% CI 1.01-1.24, p=0.02). In a model including only Carstairs scores and the EuroSCORE both were independent predictors of this outcome (OR for Carstairs score 1.11 per unit, 95% CI 1.00-1.22, p=0.04). Thirty-day mortality increases in each quartile of Carstairs scores, with patients in quartile 4 (most deprived) at significantly higher risk compared to quartile 1 (uncorrected OR 2.53 per unit, 95% CI 1.04-6.15; OR corrected for EuroSCORE, 2.56 per unit, 95% CI 1.03-6.34, p=0.04 for both). Similarly, patients in the least affluent quartile were twice as likely to suffer a serious complication as those in the most affluent quartile (OR 2.14 per unit, 95% CI 1.32-3.46, p=0.002). This increased risk was also independent of the EuroSCORE.
Conclusions: Lower SES is associated with a poorer early outcome following CABG and is independent of other recognised risk factors.
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