Socioeconomic Disadvantage Association with Disease Severity and Adverse Outcomes after Interhospital Transfer for Vascular Care.

BACKGROUND

Interhospital transfer is a key pathway to specialized vascular care, but the relationship between socioeconomic disadvantage and disease severity and outcomes among transferred patients remains unclear. We evaluated transfer characteristics, clinical outcomes, and the association between residence-level socioeconomic factors and post transfer outcomes, with disease-specific analysis in chronic limb-threatening ischemia (CLTI).

METHODS

We conducted a retrospective cohort study of adult patients transferred to a major regional referral center for vascular surgical evaluation between January 2023 and September 2025. Patient addresses were geocoded and linked to US census tract-level socioeconomic variables, including poverty, education, income, uninsured rate, unemployment, no vehicle rate, and a composite deprivation score. Outcomes included hospital admission, intensive care unit (ICU) admission, in-hospital mortality, and hospital length of stay (LOS). CLTI-specific analyses evaluated Rutherford stage and amputation rates.

RESULTS

A total of 675 patients were included; 69.8% underwent intervention, and 37.6% required ICU care. The mean LOS was 9.54 days. Average travel time to the receiving center was approximately 60 min. Socioeconomic disadvantage was associated with ICU admission, mortality, and longer LOS (P < 0.05). In CLTI patients, unemployment and composite deprivation differed across Rutherford categories (P < 0.05), with greater disadvantage in advanced stages. Patients undergoing amputation (n = 59) resided in areas with lower income, higher poverty, lower education, and higher deprivation (all P < 0.05).

CONCLUSION

Socioeconomic disadvantage is associated with worse outcomes among transferred vascular patients and with greater ischemic severity and limb loss in CLTI. These findings suggest that access-related barriers contribute to disease progression prior to transfer.