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| Journal of the New Zealand Medical Association, 29-June-2012, Vol 125 No 1357 |
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[full text] [PDF] The most deprived Auckland City Hospital patients (2005–2009) are 10 years younger and have a 50% increased mortality following discharge from a cardiac or vascular admission when compared to the least deprived patients
Chris Ellis, Andie Pryce, Garth MacLeod, Greg Gamble
AbstractAim To examine how socioeconomic deprivation affects medium to long-term patient outcomes following hospital discharge for a cardiac or vascular admission. Methods We performed a retrospective analysis of all patients aged ≥15 years of age discharged from Auckland City Hospital between 1/7/2005 and 31/12/2009 with a cardiac or vascular diagnostic-related group (DRG) using prospectively collected data from their Auckland District Health Board (ADHB) discharge, including their ‘deprivation index’, a small area marker of socioeconomic deprivation graded as 1 (the least deprived) to 10 (the most deprived). We then matched these data with the ADHB admissions patient data (for subsequent readmissions) and with the National death registry. Results In these 4.5 years, 252,974 patients, resident in the ADHB region, were discharged from the ADHB, of whom 19,545 patients had presented with a cardiac or vascular DRG. Of these, 3,609 (18%) patients [mean age 66 (SD18) years] with a deprivation index of 1 or 2 were classified as ‘least deprived’, with 3812 (20%) patients [mean age 57 (SD19) years] with a deprivation index of 9 or 10 being classified as ‘most deprived’. The most deprived patients were, on average, 10 years younger (P<0.0001). 344 [1.8% (95%CI 1.6–1.9)] patients died in hospital and 2970 [15.2% (95%CI 14.8–15.6)] died within a mean follow-up of 2.5 (SD1.4) years. Compared with those least deprived (NZDep Index 2006 1-2) the age and gender adjusted risk of death in the most deprived (NZDep Index 2006 9-10) at median 2.4 years after discharge, was increased by 50% [OR 1.5 (95%CI 1.3–1.7) P<0.0001]. Conclusions Following discharge after a cardiac or vascular related admission and after adjusting for imbalance in age and gender, and also in models with adjustment for age, gender and ethnicity, socioeconomic deprivation was associated with an increased chance of death and hospitalisation following discharge. Despite programmes to minimise health disparities, comprehensive strategies to improve on this health inequality are still needed within the New Zealand health care environment.
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