Low socioeconomic status raises mortality odds in pulmonary conditions
Click Here to Manage Email Alerts
Key takeaways:
- Residence in areas with low vs. high socioeconomic status raised the likelihood of mortality and readmission.
- This analysis adjusted for access to health care resources and hospital characteristics.
Among hospitalized patients with various pulmonary conditions, living in a low socioeconomic status area heightened the odds for 30-day mortality and readmission, according to results published in Annals of the American Thoracic Society.
“We found that neighborhood socioeconomic deprivation was associated with increased 30-day mortality for common pulmonary conditions in a large study of nearly 1.5 million Medicare admissions, after adjustment for individual poverty, age, sex, comorbid condition burden, access to health care resources and health care facility characteristics,” Jay B. Lusk, MD, MBA, internal medicine resident at Duke University Health System, and colleagues wrote.
Using 2016 to 2019 U.S. Medicare inpatient and outpatient claims, Lusk and colleagues conducted a retrospective, population-level cohort study of patients hospitalized with various pulmonary conditions — pulmonary infections, chronic lower respiratory disease, pulmonary embolism and pleural and interstitial lung disease — to assess the link between neighborhood socioeconomic deprivation and 30-day mortality and readmission.
Neighborhood socioeconomic deprivation was found through the area deprivation index, which combines 17 data points from the U.S. census related to income, education, employment and housing and scores areas on a scale of 1 to 100. A higher score indicates low socioeconomic status.
Researchers observed associations between the two factors using estimated logistic regression models.
Notably, the models adjusted for several variables, including demographics (age, sex, Medicare-Medicaid dual eligibility, comorbidity burden), access to health care resources and characteristics of admitting health care facilities.
Mortality
Within the cohort that evaluated 30-day mortality in relation to socioeconomic status (n = 1,417,040), there was a high number of patients with respiratory infections (n = 738,319) and chronic lower respiratory disease (n = 480,343), with smaller numbers of patients with pulmonary embolism (n = 118,428) and ILD (n = 79,950).
In all four pulmonary conditions, researchers found heightened odds for 30-day mortality among those who lived in low (85th percentile) vs. high (1st percentile) socioeconomic status neighborhoods.
Patients with chronic lower respiratory disease residing in an area with a low socioeconomic status had the highest odds for this outcome (aOR = 1.31; 95% CI, 1.22-1.41), followed by patients with pulmonary embolism (aOR = 1.26; 95% CI, 1.13-1.4), patients with respiratory infections (aOR = 1.2; 95% CI, 1.16-1.25) and patients with ILD (aOR = 1.15; 95% CI, 1.04-1.27).
During this analysis, researchers also noted how the link between mortality and socioeconomic status changed with each adjustment.
“Access to health care resources contributes to this association but does not explain the majority of the effect, and health care facility characteristics appear to have little contribution to this effect,” Lusk and colleagues wrote.
Readmission
Pulmonary condition prevalence in the 30-readmission cohort (n = 1,389,097) was similar to that observed in the mortality cohort, with larger numbers of patients with respiratory infections (n = 716,333) and chronic lower respiratory disease (n = 472,814) and smaller numbers of patients with pulmonary embolism (n = 120,267) and ILD (n = 79,683).
When evaluating 30-day readmission, patients from low (85th percentile) vs. high (1st percentile) socioeconomic status neighborhoods had an increased likelihood for this negative outcome; however, not all pulmonary condition groups demonstrated this relationship.
Researchers found higher odds for readmission among patients living in low socioeconomic areas with pulmonary embolism (aOR = 1.17; 95% CI, 1.07-1.27), respiratory infections (aOR = 1.09; 95% CI, 1.05-1.12) and chronic lower respiratory disease (aOR = 1.08; 95% CI, 1.04-1.13).
“Additional research is urgently needed to determine what mechanisms lead to poor outcomes for patients from socioeconomically disadvantaged communities and then to ensure that policy and clinical strategies can be implemented to promote population-level health equity for patients with pulmonary conditions,” Lusk and colleagues wrote.
Findings from this study highlight the importance of efforts that aim to improve neighborhoods with a low socioeconomic status, according to an accompanying editorial by Manpreet Kaur, MA, from the department of sociology at Case Western Reserve University, and colleagues.
“Investigators and clinical leaders must pursue large-scale observational studies, cost-effectiveness evaluations, community improvement programming and policy changes that act on the social determinants of health by improving air quality in homes, increasing accessible green space and improving economic opportunities,” Kaur and colleagues wrote. “These efforts should include eliciting community members’ own preferences for how to best support neighborhoods in ways that narrow the disparities in lung health.”