The Association of Socio-Environmental Inequality and Outcomes Among Patients Undergoing Major Surgery

• Published in: The Journal of surgical research Vol. 301; pp. 664 - 673
• Main Authors: Catalano, Giovanni, Munir, Muhammad Musaab, Chatzipanagiotou, Odysseas P., Woldesenbet, Selamawit, Altaf, Abdullah, Khan, Muhammad Muntazir M., Rashid, Zayed, Pawlik, Timothy M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Environmental justice; Major surgery; Social–environmental inequality; Textbook outcome; Social–environmental inequality; Major surgery; Textbook outcome; Environmental justice
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.07.063

Environmental hazards may influence health outcomes and be a driver of health inequalities. We sought to characterize the extent to which social–environmental inequalities were associated with surgical outcomes following a complex operation. In this cross-sectional study, patients who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy, pneumonectomy, or pancreatectomy between 2016 and 2021 were identified from Medicare claims data. Patient data were linked with social–environmental data sourced from Centers for Disease Control and Agency for Toxic Substances and Disease Registry data based on county of residence. The Environmental Justice Index social–environmental ranking (SER) was used as a measure of environmental injustice. Multivariable regression analysis was performed to assess the relationship between SER and surgical outcomes. Among 1,052,040 Medicare beneficiaries, 346,410 (32.9%) individuals lived in counties with low SER, while 357,564 (33.9%) lived in counties with high SER. Patients experiencing greater social–environmental injustice were less likely to achieve textbook outcome (odds ratio 0.95, 95% confidence interval 0.94-0.96, P < 0.001) and to be discharged to an intermediate care facility or home with a health agency (odds ratio 0.97, 95% confidence interval 0.96-0.98, P < 0.001). Cumulative social and environmental inequalities, as captured by the Environmental Justice Index SER, were associated with postoperative outcomes among Medicare beneficiaries undergoing a range of surgical procedures. Policy makers should focus on environmental, as well as socioeconomic injustice to address preventable health disparities.