Coronary artery bypass graft surgery: socioeconomic inequalities in accessand in 30 day mortality. A population-based study in Rome, Italy

Objectives-To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in ac cordance with need. To estimate the association between SES and mortality o ccurring 30 days after CABG surgery. Design-Individual socioeconomic index assigned with respect to the characteristics of the census tract of residen ce (level I highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who unde rwent CABG surgery during 1996-97. Setting-Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city. Participants-All residents in Rome aged 35 years or more. A coho rt of 1875 CABG patients aged 35 years or more. Main outcome measures-Age adjusted hospitalisation rates for CABG and IHD a nd rate of CABG per 100 IHD hospitalisations by SES group, taking level I a s the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospit al where CABG was performed. Results-People in the lowest SES level experienced an excess in the age adj usted MD hospitalisation rates compared with the highest SES level (an exce ss of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantag ed level (8.9 CABG procedures per 100 MD hospital admissions in level IV ve rsus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most sociall y disadvantaged SES group experienced a higher risk of 30 day mortality aft er CABG surgery (8.1%) than those in the highest SES group (4.8%); this exc ess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80). Conclusions-The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Facto rs related to SES are likely to influence poor prognosis after CABG surgery .