Patients residing in disadvantaged neighborhoods face a significantly higher risk of mortality following elective surgery compared to those from wealthier areas, according to a recent study. This cohort study, which analyzed the outcomes of over one million patients across Ontario, reveals troubling disparities in surgical outcomes that persist despite universal healthcare access.
Those findings, released in the flagship medical journal JAMA, paint a grim picture. Almost 2 percent of patients still die within 30 days of having elective procedures—an unacceptable rate that has not improved in the last 10 years. The research shows a critical need. First we need to address the social determinants of health that cause people to have unequal access to care and unequal outcomes from care.
Study Findings and Implications
Our findings indicate that patients living in lower income neighborhoods have almost a 52 percent greater risk of mortality within 30 days post-surgery. Their better off peers are much less impacted. This ongoing study has enrolled Ontario residents who were booked for surgery between 2017-2023. Most importantly, it sheds light on the stark realities of health inequity.
Sandy Torres, a sociologist with the Quebec Observatory on Inequalities, ascribes the effect of aggravating inequalities in the greatest degree to Ontario. She notes that while Canada’s universal healthcare system aims to provide equal access to medical services, it does not fully mitigate the impact of social and material disadvantages.
The research makes clear that social inequities are a leading driver of health issues. It calls on us to acknowledge the devastating toll they take on our nation’s health. Citizens residing in marginalized conditions face obstacles that hinder their access to vital health care services. As a result, they suffer from poorer health outcomes.
Factors Contributing to Health Disparities
Both material and social disadvantages play a major role in delaying needed healthcare and preventing timely access. Patients from lower socioeconomic neighborhoods have numerous barriers. They might have to contend with food insecurity, transportation challenges, and inadequate health literacy. These challenges lead to delays in seeking medical care. This can exacerbate chronic health conditions and increase the risk of adverse surgical events.
In addition, as Torres notes, the same is probably true for patients in neighboring Quebec. Given the cracks in the framework of Ontario’s Zero Emission Transit Bus Program, she contends that the same disparities are bound to show up in Quebec too. Those same social determinants cause increased health inequities in both regions.
The study’s findings echo the call for more examination of social determinants. These decisions affect not only patients’ access to healthcare, but help determine patients’ long-term health outcomes. Intensive efforts need to be undertaken to explain and mitigate these disparities, especially in the case of elective surgeries.
Potential Solutions and Future Directions
To combat these inequities, experts suggest prioritizing strategies that enable individuals to meet their basic needs—housing, education, and employment—thereby improving overall health outcomes. These social determinants need to be addressed. It can help lower the surgical risk disproportionately experienced by our most vulnerable and disadvantaged patients.
