More Money, Less Problems: Household Disposable Income and Survival After Cardiac Surgery

Study Questions:

What is the association between household disposable income and long-term mortality after cardiac surgery?


This was a Swedish nationwide population-based observational study. The authors included all patients who underwent cardiac surgery (coronary artery bypass graft surgery, valve repair/replacement, or a combination of both) between 1999 and 2012. Information regarding income, education, marital status, medical history, and cardiovascular risk factors was obtained. Household disposable income was categorized according to quintiles from lowest to highest income. The primary outcome measure was death from any cause.


Among 100,534 patients and during a mean follow-up of 7.3 years, 29,176 (29%) patients died. There was a stepwise inverse association between household disposable income and all-cause mortality. After multivariable adjustment, the hazard ratio for death was 0.71 (95% confidence interval, 0.67-0.75) in the highest compared with the lowest household disposable income quintile.


The authors concluded that household disposable income was independently associated with increased early and long-term mortality after cardiac surgery.


This is an important study that demonstrates the strong association between household disposable income and mortality. This association persisted after adjustment for cardiovascular risk factors, comorbidities, and other variables of socioeconomic status. Importantly and as the authors point out, all patients benefitted from a universal-tax financed health care system. Accordingly and because the association between household disposable income and mortality cannot be explained by access to care alone, the authors correctly suggest that future studies should identify “ways to better implement secondary prevention low-income patient groups.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias

Keywords: Cardiac Surgical Procedures, Cardiovascular Diseases, Comorbidity, Coronary Artery Bypass, Income, Mortality, Outcome Assessment (Health Care), Risk Factors, Secondary Prevention, Survival

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