Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.

<h4>Objectives</h4>To examine the effect of socioeconomic status (SES) on mortality in patients with bacteremia and the underlying factors that may mediate differences in mortality.<h4>Methods</h4>We conducted a population-based cohort study in two Danish regions. All patient...

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Autores principales:	Kristoffer Koch, Mette Nørgaard, Henrik Carl Schønheyder, Reimar Wernich Thomsen, Mette Søgaard, Danish Collaborative Bacteremia Network
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e95512f836ca47da922a13c0c362e907
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spelling	oai:doaj.org-article:e95512f836ca47da922a13c0c362e9072021-11-18T09:02:52ZEffect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.1932-620310.1371/journal.pone.0070082https://doaj.org/article/e95512f836ca47da922a13c0c362e9072013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23936145/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>To examine the effect of socioeconomic status (SES) on mortality in patients with bacteremia and the underlying factors that may mediate differences in mortality.<h4>Methods</h4>We conducted a population-based cohort study in two Danish regions. All patients 30 to 65 years of age with first time bacteremia from 2000 through 2008 were identified in a population-based microbiological bacteremia database (n = 8,653). Individual-level data on patients' SES (educational level and personal income) and comorbid conditions were obtained from public and medical registries. We used Cox regression to examine mortality within 30 days after bacteremia with and without cumulative adjustment for potential mediators.<h4>Results</h4>Bacteremia patients of low SES were more likely to live alone and be unmarried than patients of high SES. They also had more pre-existing comorbidity, more substance abuse, more Staphylococcus aureus and nosocomial infections, and more admissions to small nonteaching hospitals. Overall, 1,374 patients (15.9%) died within 30 days of follow-up. Patients of low SES had consistently higher mortality after bacteremia than those of high SES crude hazard ratio for low vs. high education, 1.38 [95% confidence interval (CI), 1.18-1.61]; crude hazard ratio for low-income vs. high-income tertile, 1.58 [CI, 1.39-1.80]. Adjustment for differences in social support, pre-existing comorbidity, substance abuse, place of acquisition of the infection, and microbial agent substantially attenuated the effect of SES on mortality (adjusted hazard ratio for low vs. high education, 1.15 [95% CI, 0.98-1.36]; adjusted hazard ratio for low-income vs. high-income tertile, 1.29 [CI, 1.12-1.49]). Further adjustment for characteristics of the admitting hospital had minimal effect on observed mortality differences.<h4>Conclusions</h4>Low SES was strongly associated with increased 30-day mortality after bacteremia. Less social support, more pre-existing comorbidity, more substance abuse, and differences in place of acquisition and agent of infection appeared to mediate much of the observed disparities in mortality.Kristoffer KochMette NørgaardHenrik Carl SchønheyderReimar Wernich ThomsenMette SøgaardDanish Collaborative Bacteremia NetworkPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 7, p e70082 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kristoffer Koch Mette Nørgaard Henrik Carl Schønheyder Reimar Wernich Thomsen Mette Søgaard Danish Collaborative Bacteremia Network Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
description	<h4>Objectives</h4>To examine the effect of socioeconomic status (SES) on mortality in patients with bacteremia and the underlying factors that may mediate differences in mortality.<h4>Methods</h4>We conducted a population-based cohort study in two Danish regions. All patients 30 to 65 years of age with first time bacteremia from 2000 through 2008 were identified in a population-based microbiological bacteremia database (n = 8,653). Individual-level data on patients' SES (educational level and personal income) and comorbid conditions were obtained from public and medical registries. We used Cox regression to examine mortality within 30 days after bacteremia with and without cumulative adjustment for potential mediators.<h4>Results</h4>Bacteremia patients of low SES were more likely to live alone and be unmarried than patients of high SES. They also had more pre-existing comorbidity, more substance abuse, more Staphylococcus aureus and nosocomial infections, and more admissions to small nonteaching hospitals. Overall, 1,374 patients (15.9%) died within 30 days of follow-up. Patients of low SES had consistently higher mortality after bacteremia than those of high SES crude hazard ratio for low vs. high education, 1.38 [95% confidence interval (CI), 1.18-1.61]; crude hazard ratio for low-income vs. high-income tertile, 1.58 [CI, 1.39-1.80]. Adjustment for differences in social support, pre-existing comorbidity, substance abuse, place of acquisition of the infection, and microbial agent substantially attenuated the effect of SES on mortality (adjusted hazard ratio for low vs. high education, 1.15 [95% CI, 0.98-1.36]; adjusted hazard ratio for low-income vs. high-income tertile, 1.29 [CI, 1.12-1.49]). Further adjustment for characteristics of the admitting hospital had minimal effect on observed mortality differences.<h4>Conclusions</h4>Low SES was strongly associated with increased 30-day mortality after bacteremia. Less social support, more pre-existing comorbidity, more substance abuse, and differences in place of acquisition and agent of infection appeared to mediate much of the observed disparities in mortality.
format	article
author	Kristoffer Koch Mette Nørgaard Henrik Carl Schønheyder Reimar Wernich Thomsen Mette Søgaard Danish Collaborative Bacteremia Network
author_facet	Kristoffer Koch Mette Nørgaard Henrik Carl Schønheyder Reimar Wernich Thomsen Mette Søgaard Danish Collaborative Bacteremia Network
author_sort	Kristoffer Koch
title	Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
title_short	Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
title_full	Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
title_fullStr	Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
title_full_unstemmed	Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.
title_sort	effect of socioeconomic status on mortality after bacteremia in working-age patients. a danish population-based cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/e95512f836ca47da922a13c0c362e907
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Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.

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