Socio-Economic Status Affects Long-Term Survival After Critical Illness

Main Category: Public Health
Article Date: 06 Jul 2008 - 0:00 PDT

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Lower socio-economic status has more of a detrimental affect on long-term survival after critical illness than many other factors, according to a research paper published in the latest issue of Medical Journal of Australia.

Dr Kwok Ho, an intensivist from the Royal Perth Hospital, and his co-authors investigated the link between socio-economic status and outcomes for seriously-ill patients in a retrospective study over a 16-year period in Western Australia.

Dr Ho said indicators such as poor education, lower income and the type of occupation, as well as living in a disadvantaged area, were a determinant of outcomes for many diseases.

"Socio-economic status has a significant adverse effect on a critically ill patient's long-term survival over and above the background effects of age, severity of the acute illness, co-morbidities, Indigenous status and geographical access to essential services." he said.

More than 15,000 seriously-ill patients admitted to intensive care units in WA between 1987 and 2002 were analysed.

"Although socio-economic status was not significantly associated with in-hospital mortality, long-term mortality was significantly higher in patients from the most disadvantaged groups."

The attributable incidence of death after hospital discharge between patients from the lowest and highest socio-economic status groups was 1.0 per 100 person-years. This means that people from the groups with a lower socio-economic status have a higher risk of dying after discharge from hospital.

Dr Ho said there were at least two possible explanations.

"Although we adjusted for geographical accessibility of essential services, financial and cultural access to some services may have a significant effect on rehabilitation and long-term survival after critical illness.

"Lower socio-economic status is also associated with some risk factors for poor health outcomes - including smoking, alcohol misuse, poor nutrition, overcrowded accommodation and inadequate physical activity.

"More intensive targeting of such preventable or reversible risk factors in lower socio-economic patients could potentially improve long-term outcomes for these patients.

"Intensive care services are expensive and it would be a waste of resources if the aim of the treatment were only to discharge patients alive from the hospital without optimising their long-term outcome," he said.

The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

Medical Journal of Australia