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 Researchers found that even the wealthiest patients
at hospitals treating primarily poor communities tended to fare
worse after major cancer surgeries than the poorest patients at
hospitals treating primarily wealthy communities.
"We know people in the lower socioeconomic status have worse
outcomes, but it's always harder to get at the underlying mechanism
for those worse outcomes," Dr. Amir Ghaferi told Reuters Health.
Ghaferi is the study's senior author from the Center for Healthcare
Outcomes and Policy at the University of Michigan in Ann Arbor.
Several studies have found that a person's risk of death after major
cancer surgery is linked to economic status, Ghaferi and his
colleagues write in JAMA Surgery.
Poor people who have part of their stomach removed because of
cancer, for example, are 55 percent more likely to die than their
richer counterparts, the researchers note.
Economic status is often an indicator of other factors, however.
Those include a person's general health or the quality of the
healthcare available in their community.
While a hospital's quality is often measured by how many of its
patients experience complications during their stays or after
operations, the authors of the new study used a measure known as
failure to rescue or FTR.
FTR identifies patients who die after major complications following
surgery, because the hospitals were unable to "rescue" them.
"If you do develop a complication, it's very important how that
complication is recognized and ultimately treated," Ghaferi said.
For the study, he and his colleagues used data spanning the years
2003 to 2007 from Medicare, the U.S. health insurance program for
the elderly and disabled.
They identified 596,222 people who were 65 years old or older and
had a major surgery for cancer during that time. Those people were
then matched with U.S. Census data to estimate their socioeconomic
status.
As in other studies, the researchers found that the poorest patients
were more likely to die and experience complications after their
surgeries, compared to the richest patients.
They also found that about 27 percent of the poorest patients were
recorded as FTR, compared to about 23 percent of the richest
patients.
Overall, the poorest patients were about 20 percent more likely to
be FTR, compared to the richest patients.
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The disparity held after researchers took into account patient
characteristics like employment, education and other health
conditions.
But after taking into account the hospitals where the procedures
were performed, researchers found that most of the increased FTR
risk among the poorest patients disappeared.
The likelihood of FTR among patients of any economic status was
higher at hospitals that serve mostly poor communities, compared to
hospitals that serve mostly wealthy communities.
The new study can't say which aspect of care at the hospitals may
be most closely linked to FTR rates, but Ghaferi said a number of
factors could be involved.
"When it comes down to it, your surgical care doesn't happen within
a silo," he said. "It happens within the greater system of a large
or small hospital."
He added that he believes much of the increased risk of FTR may come
from the attitude a hospital and its staff have toward patient
safety.
"I have for a long time been worrying that part of the disparity is
that poor folks tend to get their healthcare in poor health
systems," Dr. Otis Brawley told Reuters Health.
Brawley, who was not involved in the new study, is chief medical
officer of the American Cancer Society in Atlanta.
"If you have the opportunity to pick the hospital you can go to, you
should go to a hospital that has a high volume of doing the
operation you need," he said.
He added, however, that poor people living in urban areas may have
few options. ___
Source: http://bit.ly/1cXioxH
JAMA Surgery, online March 12, 2014.
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