{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:23:00Z","timestamp":1792027380311,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Prior research conducted in private for-profit health care systems has suggested that social determinants of health (SDOH) play a role in adverse postoperative outcomes. Whether these findings translate to universal health care systems is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To quantify the association of SDOH with risk of 30-day mortality after scheduled inpatient surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study was conducted in Ontario, Canada\u2019s most populous province. The cohort included consecutive adult patients (aged \u226518 years) who were eligible for Ontario\u2019s universal health insurance and underwent a scheduled inpatient surgical procedure between January 1, 2017, and December 31, 2023. Diagnostic and procedural, demographic, vital statistics, and other data were obtained from linked health administrative databases.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n SDOH including neighborhood income, immigration status, and migration recency.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Death within 30 days of index surgery. Logistic regression models were used to estimate the adjusted and unadjusted odds ratios (AORs and ORs) of the association of each SDOH with 30-day mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 1\u202f036\u202f759 patients (median [IQR] age, 66 [56-74] years; 526\u202f158 females [50.8%]) who underwent a range of scheduled inpatient surgical procedures were included. Of these patients, 1780 (0.9%) from the lowest-income areas died, as did 1307 (0.6%) from the highest-income areas. Patients from the lowest-income areas were at 52.0% increased odds of death (OR, 1.52; 95% CI, 1.42-1.64) compared with those from the highest-income areas. This association persisted with models partially adjusted for demographic and procedural factors (AOR, 1.54; 95% CI, 1.44-1.66) and fully adjusted for comorbidities (AOR, 1.43; 95% CI, 1.33-1.54). A dose-response association was demonstrated between neighborhood income and mortality, with odds of death increasing with diminishing income (eg, quintile 3 vs quintile 5: AOR, 1.18 [95% CI, 1.10-1.27]; quintile 2 vs quintile 5: AOR, 1.32 [95% CI, 1.22-1.42]). There was evidence of effect modification of the association between neighborhood income and mortality by procedure complexity (eg, effect estimate for quintile 4 and high complexity: \u20130.0776 [95% CI, \u20130.2722 to 0.1169];\n P<\/jats:italic>\n \u2009=\u2009.002). Immigrant and refugee status and recent migration (&amp;lt;5 years) demonstrated reduced odds of mortality in unadjusted analyses, but these associations diminished with risk adjustment.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, residency in lowest-income neighborhood was associated with increased risk of postoperative mortality despite adjustment for patient, procedure, and hospital factors. Improving postoperative outcomes likely requires addressing underlying SDOH disparities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.53228","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T16:00:21Z","timestamp":1768233621000},"page":"e2553228","source":"Crossref","is-referenced-by-count":3,"title":["Social Determinants of Health and 30-Day Mortality After Inpatient Elective Surgery"],"prefix":"10.1001","volume":"9","author":[{"given":"Ashwin","family":"Sankar","sequence":"first","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Unity Health Toronto\u2013St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"ICES Central, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Ding","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Black","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Unity Health Toronto\u2013St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Wilton","sequence":"additional","affiliation":[{"name":"ICES Central, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"ICES Central, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duminda N.","family":"Wijeysundera","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia, Unity Health Toronto\u2013St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"ICES Central, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy N.","family":"Baxter","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"ICES Central, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gomez","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"ICES Central, Toronto, Ontario, Canada"},{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of General Surgery, Unity Health Toronto\u2013St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, 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