Social Determinants of Health and 30-Day Mortality After Inpatient Elective Surgery

How are social determinants of health (neighborhood income, immigration status, and migration recency) associated with 30-day mortality after inpatient elective surgery in a universal health care system?In this cohort study including 1 036 759 patients who underwent scheduled surgical procedures, patients from the lowest-income neighborhoods had higher odds of 30-day mortality than those from the highest-income areas, even after adjusting for patient, procedure, and hospital factors. The association showed a dose-response pattern and persisted across study periods; immigration-related factors were not associated with mortality.In this study, lower neighborhood income was associated with higher postoperative mortality, suggesting that improving surgical outcomes may require addressing disparities in social determinants of health.

Corresponding Author: Ashwin Sankar, MD, MSc, Department of Anesthesiology and Pain Medicine, University of Toronto, 30 Bond St, Toronto, ON M5B1W8, Canada (ashwin.sankar@mail.utoronto.ca).

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