P

eople living in poorer postcodes have a greater risk of dying after having cardiac surgery than wealthier counterparts, a study has found.

Published on the British Medical Journal online, the study looked at almost 45,000 patients, with an average age of 65 years, to assess the effects of social deprivation on survival following a range of cardiac surgical procedures.

Of these patients who underwent cardiac surgery between 1997 and 2007 in five hospitals in Birmingham and North West England, 3.25% died in hospital following the surgery and 12.4% died during a five-year follow-up. The researchers found social deprivation was a strong independent predictor of death.

The social deprivation of the patients was calculated based on their postcode at the 2001 census for England and Wales.

The researchers found smoking, obesity and diabetes were all associated with lower socioeconomic status, and were each responsible for a significant reduction in survival following surgery, with diabetes carrying a 31% increased risk and smoking a 29% increased risk of death.

Adjusting for these factors did reduce the impact, but the researchers believed other factors related to deprivation also had a negative effect on survival as deprivation was still seen to increase mortality risk. “This study raises the concern that the effect of proven healthcare interventions, like cardiac surgery, may not be equally distributed across socioeconomic boundaries,” the authors said.

“But the real challenge lies in developing a coherent health conscious approach to education and to the environment. This is essential to maximise the benefits of expensive and complex healthcare interventions such as cardiac surgery,” they concluded.

A BMJ accompanying editorial by cardiac specialists at Edinburgh Royal Infirmary said the study highlighted the need to target the rehabilitation process of more socially deprived patients after cardiac surgery. Systems needed to be put in place to narrow the gap between the rich and the poor, they said.