Ontarians from low-income neighbourhoods face a substantially higher risk of death after surgery than people from the highest-income areas in the province, according to research from St. Michael's Hospital, Unity Health Toronto and the University of Toronto.
The study, which was published in JAMA Network Open , analyzed more than a million patients who underwent planned, in-patient surgery across Ontario between 2017 and 2023. Data was gathered at ICES , an independent research institute that analyzes health and demographic data.
Researchers found that patients from the lowest-income parts of Ontario had a 43 per cent higher chance of dying within 30 days of surgery compared to those from high-income neighbourhoods.
This pattern persisted even after researchers accounted for factors such as patients' age, existing health conditions, complexity of surgery and the hospital that provided treatment - suggesting that improving surgical outcomes requires addressing broad disparities related to social determinants of health.
"Even in a universal health-care system, not everyone faces the same risks when they come for surgery," says the study's lead author Ashwin Sankar, a clinician-investigator at St. Michael's Hospital and an assistant professor of anesthesiology and pain medicine at U of T's Temerty Faculty of Medicine. "We found clear and persistent income-based disparities. Patients from the lowest-income neighbourhoods had substantially higher odds of dying following elective surgery than patients from the wealthiest areas, despite receiving care in the same publicly funded system."
Sankar began exploring the links between social disparities and health outcomes during the COVID-19 pandemic, when access to hospitals and clinical care was limited. While this new study considers hospital-related factors, Sankar and co-authors - including Temerty medical student Josephine Ding and Associate Professor David Gomez - uncovered underlying issues beyond the operating room.
"What stood out is that hospital-level factors explained only a modest share of the variation in outcomes," Sankar says. "This suggests that the roots of these disparities lie upstream of the operating room - in the broader social and economic conditions patients face before and after surgery."
For Sankar, the study serves as a "problem statement," setting the stage to further investigate how patients from marginalized communities interact with the health care system, be it access to primary care or wait times to see specialists.
"We almost take for granted the privilege of accessing publicly funded health care," he says. "But this study shows that not everyone faces the same risk after surgery. We need to understand and improve the processes of care before and after surgery to even the playing field and make sure outcomes are not dictated by income or postal code."
The study was supported by the Canadian Institutes of Health Research, ICES and the St Michael's Hospital Medical Services Association.
This story was originally published by Unity Health Toronto
