Socioeconomic deprivation is associated with worse in-hospital survival after isolated coronary artery bypass grafting in the UK

OBJECTIVES

Previous studies have identified a correlation between socioeconomic deprivation and poorer outcomes following cardiac surgery in the USA, where healthcare is predominantly delivered through private system. However, the influence of socioeconomic deprivation in countries with universal healthcare systems, such as the UK, has been less extensively investigated. Therefore, we used the index of multiple deprivation (IMD) to evaluate the impact of socioeconomic status on early clinical outcomes following coronary artery bypass grafting (CABG) in the UK.

METHODS

All patients who underwent elective/urgent isolated CABG between 2008 and 2019 in the UK were included. The IMD, along with other perioperative characteristics, were incorporated into a regression model to determine factors associated with in-hospital mortality.

RESULTS

The analysis included 182 911 patients (median age: 67.3 years, 82.13% male). Patients were categorized into five groups based on IMD, 1: most deprived to 5 the least: 1 = 30 564, 2 = 30 815, 3 = 59 161, 4 = 31 891 and 5 = 30 480. Patients from the most socioeconomically deprived areas exhibited markedly higher rates of comorbidities and risk factors such as diabetes and had a higher rate of urgent surgical intervention. There is a small increase in in-hospital mortality when socioeconomic status declined, with rates of 1.30, 1.30, 1.24, 1.14 and 1.15% for group 1–5, respectively. Socioeconomic deprivation, particularly in income and education, was associated with an increase in in-hospital survival.

CONCLUSIONS

Socioeconomic deprivation, particularly in income and education, is associated with higher burdens of comorbidity and a small decrease in-hospital survival after CABG in the UK. This suggests that these factors may play a critical role in clinical outcomes even in a universal healthcare system.