ArticleJournal of the American Geriatrics Society2020
Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Subsyndromal Delirium in Elderly Critical Care Patients: A Meta-Analysis of Prevalence and Risk Factors.Geriatrics & gerontology international · 2026Pooled it
- Cognitive Trajectories After Major Surgery in Older Adults and Factors Associated With Severe Decline.Journal of the American Geriatrics Society · 2026Article
- Association Between ICD-Coded Delirium and Health Determinants in The Atherosclerosis Risk in Communities Study.Journal of the American Geriatrics Society · 2026Article
- Development of a deep learning-based prediction model for postoperative delirium using intraoperative electroencephalogram in adults.NPJ digital medicine · 2025Article
- Brain Microstructural Alteration and Its Implications for Postoperative Delirium in Elderly Surgical Patients: A Narrative Review.Brain and behavior · 2025Review
- Increasing representation of Asian American, Native Hawaiian, and Pacific Islander communities in aging, dementia, and caregiving research: An update from the CARE registry.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Multi-level social determinants of health, inflammation, and postoperative delirium in older adults.Journal of the American Geriatrics Society · 2025Article
- Advancing Delirium Treatment Trials in Older Adults: Recommendations for Future Trials From the Network for Investigation of Delirium: Unifying Scientists (NIDUS).Critical care medicine · 2025Article
- Changes in neighborhood disadvantage over the course of 22 years among community-living older persons.Journal of the American Geriatrics Society · 2025Article
- Association between educational level and postoperative delirium in older patients undergoing abdominal surgery: a two-sample cohort study.Frontiers in medicine · 2025Article
- Inflammatory Indices and Their Associations With Postoperative Delirium.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Article
- Neighborhood Disadvantage in a Nationally Representative Sample of Community-Living Older US Adults.JAMA network open · 2024Article
- Disparities in Delirium across the Continuum of Care and Associations with Social Determinants of Health.Seminars in neurology · 2024Review
- Delirium risk and mortality in people with pre-existing severe mental illness: a retrospective cohort study using linked datasets in England.Psychological medicine · 2024Article
- The Role of Delirium on Short- and Long-Term Postoperative Outcomes Following Major Gastrointestinal Surgery for Cancer.Annals of surgical oncology · 2024Article
- Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population.American journal of surgery · 2024Article
- Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study.Journal of the American Geriatrics Society · 2024Article
- Optimizing delirium care in the era of Age-Friendly Health System.Journal of the American Geriatrics Society · 2024Article
- Experiences of in-hospital care among dementia caregivers in the context of high neighborhood-level disadvantage.Journal of the American Geriatrics Society · 2023Article
- Lower socioeconomic status is not associated with severity of adolescent idiopathic scoliosis: a matched cohort analysis.Spine deformity · 2023Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 1 country.
Funding
Abstract
BACKGROUND/
objectivesDelirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compared neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence.
designA prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status.
settingTwo academic medical centers in Boston, MA.
participantsA total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery.
interventionThe Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage. MEASUREMENTS: Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM-S) occurring during daily hospital assessments (CAM-S Peak).
resultsResiding in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3-3.1). The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P = .009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual-level markers of socioeconomic status and cultural background were: 1.2 (0.9-1.7) for education of 12 years or less; 1.3 (0.8-2.1) for non-White race; and 1.7 (1.1-2.6) for annual household income of less than $20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk.
conclusionsNeighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.
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