Does socioeconomic status affect mortality subsequent to hospital admission for community acquired pneumonia among older persons?

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Low socioeconomic status has been associated with increased morbidity and mortality for various health conditions. The purpose of this study was twofold: to examine the mortality experience of older persons admitted to hospital with community acquired pneumonia and to test the hypothesis of whether an association exists between socioeconomic status and mortality subsequent to hospital admission for community-acquired pneumonia. Methods A population based retrospective cohort study was conducted including all older persons patients admitted to Ontario hospitals with community acquired pneumonia between April 1995 and March 2001. The main outcome measures were 30 day and 1 year mortality subsequent to hospital admission for community-acquired pneumonia. Results Socioeconomic status for each patient was imputed from median neighbourhood income. Multivariate analyses were undertaken to adjust for age, sex, co-morbid illness, hospital and physician characteristics. The study sample consisted of 60,457 people. Increasing age, male gender and high co-morbidity increased the risk for mortality at 30 days and one year. Female gender and having a family physician as attending physician reduced mortality risk. The adjusted odds of death after 30-days for the quintiles compared to the lowest income quintile (quintile 1) were 1.02 (95% CI: 0.95–1.09) for quintile 2, 1.04 (95% CI: 0.97–1.12) for quintile 3, 1.01 (95% CI: 0.94–1.08) for quintile 4 and 1.03 (95% CI: 0.96–1.12) for the highest income quintile (quintile 5). For 1 year mortality, compared to the lowest income quintile the adjusted odds ratios were 1.01 (95% CI: 0.96–1.06) for quintile 2, 0.99 (95% CI: 0.94–1.04) for quintile 3, 0.99 (95% CI: 0.93–1.05) for quintile 4 and 1.03 (95% CI: 0.97–1.10) for the highest income quintile. Conclusion Socioeconomic status is not associated with mortality in the older persons from community-acquired pneumonia in Ontario, Canada.

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Published 01 January 2005
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Journal of Negative Results in BioMedicine
BioMedCentral
Open Access Research Does socioeconomic status affect mortality subsequent to hospital admission for community acquired pneumonia among older persons? 1 2,3,4 5 Linda Vrbova , Muhammad Mamdani , Rahim Moineddin , 2,5 1,2,5,6 Liisa Jaakimainen and Ross EG Upshur*
1 Address: Department of Public Health Sciences, University of Toronto, McMurrich Building, 12 Queen's Park Crescent W, Toronto, ON, M5S 1A8, 2 3 Canada, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, Health Policy Management and 4 Evaluation, University of Toronto, McMurrich Building, 2nd Floor, 12 Queen's Park Crescent West, Toronto, ON, Ma5S 1A8, Canada, Faculty of 5 Pharmacy, University of Toronto, 19 Russell Street, Toronto, ON, M5S 2S2, Canada, Department of Family and Community Medicine, University 6 of Toronto, 256 McCaul Street, 2nd Floor, Toronto, ON, M5T 2W5, Canada and Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada Email: Linda Vrbova  linda.Vrbova@moh.gov.on.ca; Muhammad Mamdani  muhammad.mamdani@ices.on.ca; Rahim Moineddin  rahim.moineddin@utoronto.ca; Liisa Jaakimainen  liisa.jaakimainen@ices.on.ca; Ross EG Upshur*  rupshur@idirect.com * Corresponding author
Published: 08 April 2005 Received: 11 August 2004 Accepted: 08 April 2005 Journal of Negative Results in BioMedicine2005,4:4 doi:10.1186/1477-5751-4-4 This article is available from: http://www.jnrbm.com/content/4/1/4 © 2005 Vrbova et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background:Low socioeconomic status has been associated with increased morbidity and mortality for various health conditions. The purpose of this study was twofold: to examine the mortality experience of older persons admitted to hospital with community acquired pneumonia and to test the hypothesis of whether an association exists between socioeconomic status and mortality subsequent to hospital admission for community-acquired pneumonia. Methods:A population based retrospective cohort study was conducted including all older persons patients admitted to Ontario hospitals with community acquired pneumonia between April 1995 and March 2001. The main outcome measures were 30 day and 1 year mortality subsequent to hospital admission for community-acquired pneumonia. Results:Socioeconomic status for each patient was imputed from median neighbourhood income. Multivariate analyses were undertaken to adjust for age, sex, co-morbid illness, hospital and physician characteristics. The study sample consisted of 60,457 people. Increasing age, male gender and high co-morbidity increased the risk for mortality at 30 days and one year. Female gender and having a family physician as attending physician reduced mortality risk. The adjusted odds of death after 30-days for the quintiles compared to the lowest income quintile (quintile 1) were 1.02 (95% CI: 0.95–1.09) for quintile 2, 1.04 (95% CI: 0.97–1.12) for quintile 3, 1.01 (95% CI: 0.94–1.08) for quintile 4 and 1.03 (95% CI: 0.96–1.12) for the highest income quintile (quintile 5). For 1 year mortality, compared to the lowest income quintile the adjusted odds ratios were 1.01 (95% CI: 0.96–1.06) for quintile 2, 0.99 (95% CI: 0.94–1.04) for quintile 3, 0.99 (95% CI: 0.93–1.05) for quintile 4 and 1.03 (95% CI: 0.97–1.10) for the highest income quintile. Conclusion:Socioeconomic status is not associated with mortality in the older persons from community-acquired pneumonia in Ontario, Canada.
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