PMID- 31522036
OWN - NLM
STAT- MEDLINE
DCOM- 20200214
LR  - 20200214
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 245
DP  - 2020 Jan
TI  - The Impact of Income on Emergency General Surgery Outcomes in Urban and Rural 
      Areas.
PG  - 629-635
LID - S0022-4804(19)30600-6 [pii]
LID - 10.1016/j.jss.2019.08.010 [doi]
AB  - BACKGROUND: Emergency general surgery (EGS) accounts for more than 2 million U.S. 
      hospital admissions annually. Low-income EGS patients have higher rates of 
      postoperative adverse events (AEs) than high-income patients. This may be related 
      to health care segregation (a disparity in access to high-quality centers). The 
      emergent nature of EGS conditions and the limited number of EGS providers in 
      rural areas may result in less health care segregation and thereby less 
      variability in EGS outcomes in rural areas. The objective of this study was to 
      assess the impact of income on AEs for both rural and urban EGS patients. 
      MATERIALS AND METHODS: The National Inpatient Sample (2007-2014) was queried for 
      patients receiving one of 10 common EGS procedures. Multivariate regression 
      models stratified by income quartiles in urban and rural cohorts adjusting for 
      sociodemographic, clinical, and other hospital-based factors were used to 
      determine the rates of surgical AEs (mortality, complications, and failure to 
      rescue [FTR]). RESULTS: 1,687,088 EGS patients were identified; 16.60% 
      (n = 280,034) of them were rural. In the urban cohort, lower income quartiles 
      were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], 
      complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural 
      context, income quartiles were not associated with the higher odds of AE 
      (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], 
      P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52). CONCLUSIONS: Lower income is 
      associated with higher postoperative AEs in the urban setting but not in a rural 
      environment. This socioeconomic disparity in EGS outcomes in urban settings may 
      reflect health care segregation, a differential access to high-quality health 
      care for low-income patients.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - de Jager, Elzerie
AU  - de Jager E
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts; College of Medicine and 
      Dentistry, The James Cook University, Townsville, Queensland, Australia. 
      Electronic address: edejager@bwh.harvard.edu.
FAU - Chaudhary, Muhammad Ali
AU  - Chaudhary MA
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Rahim, Fatima
AU  - Rahim F
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Jarman, Molly P
AU  - Jarman MP
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Uribe-Leitz, Tarsicio
AU  - Uribe-Leitz T
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Havens, Joaquim M
AU  - Havens JM
AD  - Division of Trauma Burn and Surgical Critical Care, Department of Surgery, 
      Brigham and Women's Hospital, Boston, Massachusetts.
FAU - Goralnick, Eric
AU  - Goralnick E
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts; Department of Emergency 
      Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, 
      Massachusetts.
FAU - Schoenfeld, Andrew J
AU  - Schoenfeld AJ
AD  - Department of Orthopedic Surgery, Center for Surgery and Public Health, Brigham 
      and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Haider, Adil H
AU  - Haider AH
AD  - Department of Surgery, Center for Surgery and Public Health, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
DEP - 20190912
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Emergency Service, Hospital/statistics & numerical data
MH  - Emergency Treatment/*adverse effects/statistics & numerical data
MH  - Failure to Rescue, Health Care/statistics & numerical data
MH  - Female
MH  - Health Services Accessibility/economics/statistics & numerical data
MH  - Healthcare Disparities/*economics/statistics & numerical data
MH  - Hospital Mortality
MH  - Hospitals, Rural/statistics & numerical data
MH  - Hospitals, Urban/statistics & numerical data
MH  - Humans
MH  - Income/*statistics & numerical data
MH  - Inpatients/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*epidemiology/etiology
MH  - Retrospective Studies
MH  - Rural Population/statistics & numerical data
MH  - Surgical Procedures, Operative/*adverse effects/statistics & numerical data
MH  - United States/epidemiology
MH  - Urban Population/statistics & numerical data
MH  - Young Adult
OTO - NOTNLM
OT  - Disparities
OT  - Emergency general surgery
OT  - Health care access
EDAT- 2019/09/16 06:00
MHDA- 2020/02/15 06:00
CRDT- 2019/09/16 06:00
PHST- 2019/05/30 00:00 [received]
PHST- 2019/07/08 00:00 [revised]
PHST- 2019/08/15 00:00 [accepted]
PHST- 2019/09/16 06:00 [pubmed]
PHST- 2020/02/15 06:00 [medline]
PHST- 2019/09/16 06:00 [entrez]
AID - S0022-4804(19)30600-6 [pii]
AID - 10.1016/j.jss.2019.08.010 [doi]
PST - ppublish
SO  - J Surg Res. 2020 Jan;245:629-635. doi: 10.1016/j.jss.2019.08.010. Epub 2019 Sep 
      12.