Socio-economic Status Affects Long-term Survival After Critical Illness

Lower socio-economic status has more of a detrimental affect on long-term survival after critical illness than many other factors.

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 hisco-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.

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“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.

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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.

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“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.

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