Date of Award
January 2024
Document Type
Open Access Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Carlos Mena-Hurtado
Second Advisor
Kim Smolderen
Abstract
IntroductionThe association between community socioeconomic distress and carotid endarterectomy (CEA) outcomes is understudied. We therefore analyzed the association between the Distressed Community Index (DCI), a zip-code level measure of community distress, with 36-month post-CEA mortality and readmission.
MethodsWe thus examined patients undergoing CEA between 2015-2019 in the Vascular Quality Initiative database linked with Medicare claims outcomes data. Patients’ DCI ranged from 0 (not distressed) to 100 (distressed). The 36-month mortality was assessed by DCI quintiles using the Kaplan-Meir cumulative incidence function (CIF) and for linear DCI, using Cox regression stratified on site. For 90-day readmission, we used CIF curves and Fine-Gray models accounting for death as competing risk. Models were adjusted for patient and procedural characteristics.
Results The cohort included 33,593 patients with a mean DCI of 43.1 ±28.0, a mean age of 74.1 ±7.3 years, and 92.6% were White. The 36-month CIF of mortality varied from 16.4% in the “prosperous” to 20.8% in the “distressed” DCI quintiles (p<0.001). The mortality risk increased with a 10-point increase in DCI (unadjusted HR: 1.04; 95% CI 1.02-1.05 and adjusted HR: 1.03; 95% CI 1.02-1.04). The 90-day readmission CIF ranged from 18.1% in the “prosperous” to 19.4% in the “distressed” DCI quintiles (p=0.018).
ConclusionUltimately, this real-world CEA cohort demonstrates an increased 36-month mortality for high community distress groups.
Recommended Citation
Pajarillo, Carmen, "Distressed Community Index In Patients Undergoing Carotid Endarterectomy In Medicare-Linked Vqi Registry" (2024). Yale Medicine Thesis Digital Library. 4270.
https://elischolar.library.yale.edu/ymtdl/4270
Comments
This is an Open Access Thesis.