Most Health Outcomes Following Surgery Are Worse For Low-Income Patients, New AHRQ Study Shows

A new AHRQ study of 12 measures of outcomes following surgical procedures found that outcomes for patients from both high- and low-income geographic areas improved between 2000 and 2009. In fact, survival following two surgical procedures—coronary angioplasty and carotid endarterectomy—improved for both high- and low-income patients, and the disparity between the two groups narrowed. However, in nine of the remaining 10 outcomes studied, patients from low-income areas fared worse than patients from high-income areas across both years. For example, low-income patients had significantly increased risks for postoperative complications involving respiratory failure and lower survival rates following abdominal aortic aneurysm repair and coronary artery bypass graft. Prior research has shown that low-income patients were more likely to be either uninsured or covered by Medicaid as well as belong to a racial or ethnic minority group, the study said, noting that those characteristics were associated with poorer surgical outcomes. Theabstract and study, “Despite Overall Improvement in Surgical Outcomes Since 2000, Income-Related Disparities Persist,” co-authored by AHRQ’s Roxanne Andrews and Mehwish Qasim, a doctoral candidate at the University of Iowa, appeared in the October issue of Health Affairs.

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2013 Oct;32(10):1773-80. doi: 10.1377/hlthaff.2013.0194.

Despite overall improvement in surgical outcomes since 2000, income-related disparities persist.

Qasim M, Andrews RM.

Abstract

Despite improvements in health care, disparities in care still exist and are widening for some health measures. This study examined postsurgicaloutcomes for patients from low-income areas as compared to outcomes for those from high-income areas in the United States from 2000 to 2009. We found that postsurgical outcomes improved in general, with significant decreases in nine of twelve mortality and patient safety measures and an increase in one measure. Patients from low-income areas had worse surgical outcomes than those from high-income areas for nine of twelve measures in both 2000 and 2009. The disparities in outcomes between low- and high-income groups did not change significantly for nine of the twelve measures. For the three measures that did change significantly, in only two of the cases was the change favorable for patients from low-income areas. These findings have implications for efforts to improve surgical outcomes and health policy and indicate the need for research on the cause of continued disparities in postsurgical outcomes.