Disadvantaged Patients at Greatest Risk of Death from Vascular Disease

BOSTON – Patients who undergo vascular surgery at safety-net public hospitals across the country are more likely to die from vascular disease than those who are treated at non-safety-net hospitals, according to Mohammad H. Eslami, MD, who will present new research on vascular surgery outcomes at safety-net public hospitals at the Society for Vascular Surgery’s 2014 Vascular Annual Meeting, taking place June 4-7 at the Hynes Convention Center in Boston.

Eslami, who is a vascular surgeon at Boston Medical Center, identified 306,438 patients across the United States who underwent vascular surgery between 2003 and 2011. Patients were treated for one of three diseases affecting the blood vessels that deliver blood to and from the heart: peripheral arterial disease, carotid stenosis and non-ruptured abdominal aortic aneurysm.

“We divided patients based on the type of hospital they were treated at — safety-net public hospitals or non-safety-net hospitals, safety-net public hospitals being hospitals that have a significantly high number of low-income patients or patients who have Medicaid as their insurance payer — then looked at a few different things: their overall mortality, their median hospital charges and how many days they stayed in the hospital,” Eslami says.

His findings: Even though they were younger—their median age was 70, compared to 72 at non-safety-net hospitals—patients who were treated for vascular disease at safety-net hospitals died more often, stayed in the hospital longer and cost more to treat than patients treated at non-safety-net hospitals.

Adjusted for patient risk factors, mortality rates at safety-net and non-safety-net hospitals are similar. The problem, therefore, isn’t quality of care at hospitals; it’s access to care outside them.

“It’s not the safety-net hospital that increases mortality; it’s the type of patient who goes there,” explains Eslami, who says patients at safety-net hospitals are more likely to be low-income, female and minority; to have comorbidities, such as congestive heart failure and diabetes; and to show up at the hospital with more advanced stages of vascular disease.

“There’s a significant disparity in access to care for people who go to a safety-net hospital,” Eslami continues. “They’re sicker, so they present in a more emergent versus elective manner. Therefore, they end up having surgery in a more urgent fashion, which means they usually end up doing worse, staying in the hospital longer and having costlier care.”

A major contributor to poor outcomes for patients at safety-net hospitals is the fact that they typically lack a primary care physician—either because they can’t afford one, or because they lack the health literacy to understand its importance.

“Vascular surgery is a medical specialty,” Eslami says. “Treating vascular disease requires someone to diagnose you, then send you to a specialist. Patients who go to non-safety-net hospitals are more affluent and more likely to have a primary care physician who monitors their health and sends them to a vascular surgeon for evaluation.”

Education is one tool that can help bridge the gap between safety-net and non-safety-net patients. “Folks with vascular disease need to be diagnosed earlier, and that requires educating the community so they request evaluation when they have symptoms,” states Eslami, who says insurance is another important piece of the puzzle.

Although he’s not yet ready to publish them, early results of a separate study suggest he’s right. “We’re looking at Massachusetts as a model,” Eslami concludes. “I can’t give too much away right now, but what I can say is that universal health care in Massachusetts seems to be reducing mortality rates because everybody there has insurance.”

Editor’s Note: Dr. Mohammad Eslami will present the results of his study on Saturday, June 7, at 4:10 p.m. For the complete meeting program, please visit the event’s official website,


The Society for Vascular Surgery is a professional medical society dedicated to improving vascular health. The society is an advocate for vascular surgeons and the patients they care for. It counts more than 4,600 medical professionals as members, including surgeons, physicians and nurses. For more information about vascular health and the society, please visit the society's website,