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Socioeconomic Position Affects Survival After Heart Surgery

Lower status, but not race per se, reduces survival in a 'dose-dependent' manner

WEDNESDAY, April 7 (HealthDay News) -- In patients who undergo cardiac surgery, lower socioeconomic position -- but not race -- is associated with a significantly increased risk of mortality, according to a study published online April 6 in Circulation: Cardiovascular Quality and Outcomes.

Colleen G. Koch, M.D., of the Cleveland Clinic, and colleagues studied 23,330 patients who underwent isolated coronary artery bypass grafting, valve, or combined coronary artery bypass grafting and valve procedures. The subjects included 15,156 white men, 6,932 white women, 678 black men, and 564 black women. Compared to whites and men, blacks and women had significantly lower socioeconomic position as measured by six indicators.

After a median follow-up of 5.8 years, the researchers found that lower socioeconomic position was associated with an increased atherosclerotic disease burden, greater comorbidity, increased symptoms, and a risk-adjusted "dose-dependent" decrease in survival. After adjusting for socioeconomic position, however, the researchers found that black race was not associated with decreased survival.

"Changes in time-related survival for patients of low socioeconomic position necessitate a change in our approach to health care delivery because low socioeconomic position places the patient at risk for death out to 10 years after surgery," the authors conclude. "This necessitates access and delivery of primary prevention, early identification of cardiovascular risk factors and effective delivery of secondary prevention, and access to long-term interventions after treatment that might affect survival."

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