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

## TL;DR

In the UK, people from poorer areas have slightly worse survival rates after heart surgery, despite universal healthcare.

## Contribution

This study shows that socioeconomic deprivation affects CABG outcomes in a universal healthcare system.

## Key findings

- Patients from the most deprived areas had higher comorbidity rates and urgent surgery rates.
- In-hospital mortality was slightly higher in more deprived groups.
- Income and education deprivation were most strongly linked to survival outcomes.

## Abstract

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.

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.

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.

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.

Socioeconomic deprivation, also known as socioeconomic distress, has been reported to increase the incidence of perioperative complications, short- and long-term mortality, readmission rate and failure to rescue in cardiac surgery [1–7].