Patient socioeconomic status is an independent predictor of operative mortality

Ann Surg. 2010 Sep;252(3):552-7; discussion 557-8. doi: 10.1097/SLA.0b013e3181f2ac64.


Objective: To evaluate the impact of patient socioeconomic status (SES) on operative mortality within the context of associated factors.

Summary of background data: Outcomes disparities among surgical patients are a significant concern. Previous studies have suggested that the correlation between SES and outcomes is attributable to other patient- or hospital-level explanatory factors such as race or hospital wealth. These studies have typically focused on a single explanation for the existence of these inequalities.

Methods: Analyzing more than 1 million records of the Nationwide Inpatient Sample, we used multimodel inference to evaluate the effects of socioeconomic predictors on surgical mortality.

Results: Using univariate and multivariate logistic regression, we find that patient's SES is a strong predictor of operative mortality. Multivariate regressions incorporated many additional hospital- and patient-level covariates. A single-level increase in patient SES results in a mean decrease in operative mortality risk of 7.1%.

Conclusions: SES at the level of the individual patient has a statistically significant effect on operative mortality. Mortality is greatest among patients in the lowest socioeconomic strata. The effect of patient SES on mortality is not mitigated by other explanatory hospital- or patient-level factors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hospital Mortality*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Risk Factors
  • Social Class*
  • Surgical Procedures, Operative / mortality*
  • United States / epidemiology