title: Impact of socioeconomic status and rurality on early outcomes and mid-term survival after CABG: insights from a multicentre registry.
abstract: BACKGROUND
  We examined whether socioeconomic status and rurality influenced outcomes after coronary surgery.
  
  
  METHODS
  We identified 14,150 patients undergoing isolated coronary surgery. Socioeconomic and rurality data was obtained from the Australian Bureau of Statistics and linked to patients' postcodes. Outcomes were compared between categories of socioeconomic disadvantage (highest versus lowest quintiles, n= 3150 vs. 2469) and rurality (major cities vs. remote, n=9598 vs. 839).
  
  
  RESULTS
  Patients from socioeconomically-disadvantaged areas experienced a greater burden of cardiovascular risk factors including diabetes, obesity and current smoking. Thirty-day mortality (disadvantaged 1.6% vs. advantaged 1.6%, p>0.99) was similar between groups as was late survival (7 years: 83±0.9% vs. 84±1.0%, p=0.79). Those from major cities were less likely to undergo urgent surgery. There was similar 30-day mortality (major cities: 1.6% vs. remote: 1.5%, p=0.89). Patients from major cities experienced improved survival at seven years (84±0.5% vs. 79±2.0%, p=0.010). Propensity-analysis did not show socioeconomic status or rurality to be associated with late outcomes.
  
  
  CONCLUSIONS
  Patients presenting for coronary artery surgery from different socioeconomic and geographic backgrounds exhibit differences in their clinical profile. Patients from more rural and remote areas appear to experience poorer long-term survival, though this may be partially driven by the population's clinical profile.
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Australia.
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.affiliation: Department of Cardiothoracic Surgery, Geelong Hospital, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Australia. Electronic address: cheng-hon.yap@monash.edu.
authors.forename: Cheng-Hon
authors.initials: CH
authors.lastname: Yap
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Australia; Cardiovascular Research Centre, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
authors.affiliation: Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Hayward
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery (MMC), Monash University, Melbourne, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D015996:Survival Rate; D014505:Urban Population; D014739:Victoria / Q000453:epidemiology
keywords: Coronary artery bypass; Coronary artery disease; Rurality; Socioeconomic disadvantage; Surgery