Evidence map›Paper›PMID 30682354›Full record

ArticleThe Annals of thoracic surgery2019

Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery.

Eric J Charles, J Hunter Mehaffey, Robert B Hawkins, Clifford E Fonner, Leora T Yarboro, Mohammed A Quader, Andy C Kiser, Jeffrey B Rich, Alan M Speir, Irving L Kron and 3 more

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Article in The Annals of thoracic surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed.

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  14. Increased Rates of Unplanned Return to the Operating Room in Socioeconomically Deprived Orthopaedic Trauma Patient Populations.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Eric J CharlesDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia.
J Hunter MehaffeyDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia.
Robert B HawkinsDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia.
Clifford E FonnerVirginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
Leora T YarboroDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
Mohammed A QuaderVirginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
Andy C KiserVirginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina.
Jeffrey B RichVirginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Alan M SpeirVirginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia.
Irving L KronDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
Margaret C TracciDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia.
Gorav AilawadiDepartment of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia. Electronic address: gorav@virginia.edu.
Investigators for the Virginia Cardiac Services Quality Initiative

Funding

Cardiovascular Surgery Training ProgramT32HL007849 · NHLBI · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI KRON, IRVING L., LAUBACH, VICTOR E · 1998 to 2025
$7.0M
Network for Cardiothoracic Surgical Investigations in Cardiovascular MedicineUM1HL088925 · NHLBI · UNIVERSITY OF VIRGINIA · PI BADHWAR, VINAY, KRON, IRVING L. · 2013 to 2025
$6.8M
NHLBI NIH HHS T32 HL007849NHLBI NIH HHS UM1 HL088925
6 · The paper itself

Abstract

backgroundThe effects of socioeconomic factors other than insurance status and race on outcomes after cardiac operations are not well understood. We hypothesized that the Distressed Communities Index (DCI), a comprehensive socioeconomic ranking by zip code, would predict operative mortality after coronary artery bypass grafting (CABG).

methodsAll patients who underwent isolated CABG (2010 to 2017) in the Virginia Cardiac Services Quality Initiative database were analyzed. The DCI accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies, with scores ranging from 0 (no distress) to 100 (severe distress). Patients were stratified by DCI quartiles (I: 0 to 24.9, II: 25 to 49.9, III: 50 to 74.9, IV: 75 to 100) and compared. Hierarchical linear regression modeled the association between the DCI and mortality.

resultsA total of 19,756 CABG patients were analyzed, with mean predicted risk of mortality of 2.0% ± 3.5%. Higher DCI scores were associated with increasing predicted risk of mortality. Overall operative mortality was 2.1% (n = 424) and increased with increasing DCI quartile (I: 1.6% [n = 95], II: 2.1% [n = 77], III: 2.4% [n = 114], IV: 2.6% [n = 138]; p = 0.0009). The observed-to-expected ratio for mortality increased as level of socioeconomic distress increased. After risk adjustment for The Society of Thoracic Surgeons predicted risk of mortality, year of surgical procedure, and hospital, the DCI remained predictive of operative mortality after CABG (odds ratio, 1.14 for each 25-point increase in DCI; 95% confidence interval 1.04 to 1.26; p = 0.007).

conclusionsThe DCI independently predicts risk-adjusted operative mortality after CABG. Socioeconomic status, although not part of traditional risk calculators, should be considered when building risk models, evaluating resource utilization, and comparing hospitals.

Indexed as

Cardiac Surgical ProceduresAgedFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesRisk AdjustmentSocioeconomic Factors

Identifiers

PMID30682354
PMCPMC6535341

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.