Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery.
Aged
Boston
Delirium
/ epidemiology
Female
Hospitalization
/ statistics & numerical data
Humans
Incidence
Interviews as Topic
Male
Orthopedic Procedures
/ adverse effects
Patient Readmission
Postoperative Complications
Prospective Studies
Risk Factors
Socioeconomic Factors
Surveys and Questionnaires
Area Deprivation Index
clinical outcomes in hospitalization
delirium
delirium severity
social determinants of health
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
12
05
2020
revised:
13
07
2020
accepted:
18
07
2020
pubmed:
1
9
2020
medline:
19
3
2021
entrez:
1
9
2020
Statut:
ppublish
Résumé
Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compared neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence. A prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status. Two academic medical centers in Boston, MA. A total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery. The Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage. Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM-S) occurring during daily hospital assessments (CAM-S Peak). Residing in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3-3.1). The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P = .009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual-level markers of socioeconomic status and cultural background were: 1.2 (0.9-1.7) for education of 12 years or less; 1.3 (0.8-2.1) for non-White race; and 1.7 (1.1-2.6) for annual household income of less than $20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk. Neighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.
Sections du résumé
BACKGROUND/OBJECTIVES
Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compared neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence.
DESIGN
A prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status.
SETTING
Two academic medical centers in Boston, MA.
PARTICIPANTS
A total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery.
INTERVENTION
The Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage.
MEASUREMENTS
Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM-S) occurring during daily hospital assessments (CAM-S Peak).
RESULTS
Residing in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3-3.1). The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P = .009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual-level markers of socioeconomic status and cultural background were: 1.2 (0.9-1.7) for education of 12 years or less; 1.3 (0.8-2.1) for non-White race; and 1.7 (1.1-2.6) for annual household income of less than $20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk.
CONCLUSIONS
Neighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.
Identifiants
pubmed: 32865254
doi: 10.1111/jgs.16782
pmc: PMC7744425
mid: NIHMS1627091
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2863-2871Subventions
Organisme : NIA NIH HHS
ID : K24 AG035075
Pays : United States
Organisme : NIA NIH HHS
ID : P01AG031720 (SKI)
Pays : United States
Organisme : NIA NIH HHS
ID : K24AG035075 (PI Maracantonio)
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD010243
Pays : United States
Organisme : NIA NIH HHS
ID : R24 AG054259
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01MD010243 (PI Kind)
Pays : United States
Organisme : NIA NIH HHS
ID : RF1 AG057784
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG062715
Pays : United States
Organisme : NIA NIH HHS
ID : RF1AG057784 (PI Kind, MPI Bendlin)
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG031720
Pays : United States
Organisme : NIA NIH HHS
ID : R24AG054259 (SKI)
Pays : United States
Informations de copyright
© 2020 The American Geriatrics Society.
Références
AMIA Annu Symp Proc. 2018 Apr 16;2017:1547-1553
pubmed: 29854224
J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1307-11
pubmed: 17234825
JAMA. 2010 Jul 28;304(4):443-51
pubmed: 20664045
Int J Epidemiol. 2006 Aug;35(4):888-901
pubmed: 16585055
J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):790-9
pubmed: 17178826
Int J Methods Psychiatr Res. 2011 Mar;20(1):40-9
pubmed: 21499542
Ann Intern Med. 2014 Dec 2;161(11):765-74
pubmed: 25437404
Acta Neuropathol. 2010 Jun;119(6):737-54
pubmed: 20309566
Am J Phys Med Rehabil. 2013 Aug;92(8):715-27
pubmed: 23756434
JAMA Intern Med. 2015 Apr;175(4):512-20
pubmed: 25643002
J Neurosurg Anesthesiol. 2019 Apr;31(2):212-217
pubmed: 30557230
Ann Intern Med. 1990 Dec 15;113(12):941-8
pubmed: 2240918
Psychosom Med. 2006 May-Jun;68(3):414-20
pubmed: 16738073
Neurosci Biobehav Rev. 2010 Sep;35(1):2-16
pubmed: 19822172
Am J Public Health. 2019 Jan;109(S1):S16-S20
pubmed: 30699025
Neurology. 1998 May;50(5):1238-45
pubmed: 9595969
J Geriatr Psychiatry Neurol. 1992 Jan-Mar;5(1):14-21
pubmed: 1571069
J Am Geriatr Soc. 2015 Dec;63(12):2463-2471
pubmed: 26662213
Adm Policy Ment Health. 2014 Sep;41(5):572-87
pubmed: 23689992
Inquiry. 2004 Spring;41(1):21-38
pubmed: 15224958
N Engl J Med. 2017 Oct 12;377(15):1456-1466
pubmed: 29020579
Anesthesiology. 2009 Apr;110(4):781-7
pubmed: 19326492
J Am Geriatr Soc. 2018 Jul;66(6):1158-1164
pubmed: 29648689
Health Serv Res. 2019 Feb;54 Suppl 1:206-216
pubmed: 30468015
J Am Geriatr Soc. 2015 May;63(5):977-82
pubmed: 25944109
J Gerontol A Biol Sci Med Sci. 2008 Jul;63(7):764-72
pubmed: 18693233
Am J Epidemiol. 2000 Aug 1;152(3):272-8
pubmed: 10933274
J Am Geriatr Soc. 2014 Mar;62(3):518-24
pubmed: 24512042
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Ann Intern Med. 2019 Jul 16;171(2):91-98
pubmed: 31261378
N Engl J Med. 2018 Jun 28;378(26):2456-2458
pubmed: 29949490
Int Psychogeriatr. 2001 Mar;13(1):37-49
pubmed: 11352333
Ann Intern Med. 1993 Sep 15;119(6):474-81
pubmed: 8357112
Alzheimers Dement. 2016 Jul;12(7):766-75
pubmed: 27103261
Crit Care Med. 2017 Aug;45(8):1295-1303
pubmed: 28481752
JAMA Neurol. 2020 Apr 1;77(4):451-460
pubmed: 31904767
Palliat Med. 2013 Jun;27(6):486-98
pubmed: 22988044
JAMA Netw Open. 2020 Jan 3;3(1):e1919928
pubmed: 31995211
Psychol Med. 1991 Aug;21(3):785-90
pubmed: 1946866
J Clin Psychiatry. 1987 Aug;48(8):314-8
pubmed: 3611032
Am J Public Health. 2003 Jul;93(7):1137-43
pubmed: 12835199
Lancet. 2014 Mar 8;383(9920):911-22
pubmed: 23992774
Ann Intern Med. 2014 Apr 15;160(8):526-533
pubmed: 24733193
Gerontologist. 1996 Apr;36(2):230-8
pubmed: 8920094
J Am Geriatr Soc. 2000 Oct;48(10):1285-91
pubmed: 11037017
Am J Med. 2007 Sep;120(9):807-13
pubmed: 17765051
J Am Geriatr Soc. 2012 Apr;60(4):669-75
pubmed: 22316182
Cochrane Database Syst Rev. 2016 Nov 21;11:CD011333
pubmed: 27869298