Surgical Outcomes and Income-Related Disparities

Mehwish Qasim PhD Candidate, Research & Teaching Assistant Department of Health Management and Policy University of Iowa, College of Public Interview with:
Mehwish Qasim
PhD Candidate, Research & Teaching Assistant
Department of Health Management and Policy
University of Iowa, College of Public Health What are the main findings of the study?

Answer: This study focused on two questions: Do patients living in the poorest communities have worse post-surgical outcomes than those in the wealthiest communities? And has the level of these differences in post-surgical outcomes changed over time?

We found that although post-surgical outcomes improved in general from 2000-2009, (significant decreases in nine of twelve mortality and patient safety measures), patients from low-income areas had worse surgical outcomes than those from high-income areas for nine of twelve measures in both 2000 and 2009. The disparities in outcomes between low- and high-income groups did not change significantly for nine of the twelve measures. Were any of the findings unexpected?

Answer: There is a large body of evidence identifying low socioeconomic status as a risk factor for a whole host of diseases and poor outcomes, therefore, we had hypothesized that patients residing in the poorest communities would fare worse on many of the twelve patient safety and mortality measures examined. Perhaps, the lack of any significant change in most of the disparities between low- and high-income groups is unexpected because of widespread quality and safety improvement initiatives at the hospital, state, and national levels. What should clinicians and patients take away from your report?

Answer: This study found encouraging results in two areas.

  • First, nearly all post-surgical outcomes improved for patients from both low- and high-income communities between 2000 and 2009.
  • Second, disparities between patients from low-income areas and those from high-income areas improved for two of the mortality measures.

However, patients from low-income areas continued to have worse outcomes for most of the surgical measures. The reasons for the persistence in disparities in outcomes by income should be examined in future research to tease out the specific and unique contributions of patient risk factors and medical care characteristics that contribute to poor surgical outcomes for patient residing in poorer communities. What recommendations do you have for future research as a result of this study?

Answer: Understanding why disparities in outcomes remain is important for developing policies and interventions to improve quality of care. Researchers should examine whether and how differences in medical care received and differences at the patient level contribute to the persistence of disparities in surgical outcomes. Future research could employ more detailed clinical information to examine whether unmeasured clinical factors explain the disparities and multivariate analyses could be used to help tease out the unique contribution of low-income status and patient characteristics to post-surgical outcomes.


Despite Overall Improvement In Surgical Outcomes Since 2000, Income-Related Disparities Persist
Qasim M, Andrews RM.
Health Aff (Millwood). 2013 Oct;32(10):1773-80. doi: 10.1377/hlthaff.2013.0194.