P119. Beyond the Average: A Geospatial Analysis Revealing Bimodal and Trimodal Patterns in the Community-Level Drivers of CABG Mortality
Lewis Katz School of Medicine at Temple University
Philadelphia, GA
United States - Contact Me
Priya Joshi is a medical student at the Lewis Katz School of Medicine at Temple University with a primary interest in adult cardiac surgery. Her research portfolio investigates the intersection of clinical outcomes, surgical innovation, and healthcare policy. Under the mentorship of Dr. Suyog Mokashi, her work focuses on structural heart disease and the systemic factors affecting surgical reimbursement. Her work with Dr. Yanagida, Dr. Kashem, and Dr. Toyoda analyzes intraoperative variables in heart and lung transplants. Additionally, she has conducted research regarding congenital heart disease at the Children’s Hospital of Philadelphia with Dr. Gaynor and research regarding female representation in trauma surgery
Beyond her research, Priya is a dedicated leader and advocate for surgical education. She is the Co-President of the Babcock Surgical Society, where she founded the school’s Cardiothoracic Surgery Interest Group. She also served as Co-President of the Association of Women Surgeons and as the Co-Director of the THRIVE Clinic, providing free healthcare services to unhoused individuals in the North Philadelphia community.
Her poster at AATS 2026, "Mapping the Economics of ECMO: Geographic Variation in U.S. Reimbursement Patterns," utilizes 2022 CMS inpatient data to examine the correlation between regional GDP and Medicare payments. By identifying a more than threefold variation in reimbursement between states, her research aims to highlight the economic disparities that impact the delivery of high-acuity surgical care.
Description
Methods: Using public Centers for Medicare & Medicaid Services (CMS), Census, and Environmental Protection Agency (EPA) data, we identified a 2023 cohort of 850 US hospitals performing CABG. We defined granular, patient-flow-derived Hospital Service Areas (HSAs) for each. We calculated a population-weighted Area Deprivation Index (ADI) and Particulate Matter (PM2.5) pollution exposure for each HSA. Geographically Weighted Regression (GWR) was used to model the local association between risk-adjusted 30-day CABG mortality and these community factors, controlling for hospital ownership.
Results: A standard ordinary least squares (OLS) model confirmed that higher ADI was a significant predictor of increased mortality nationally (coefficient: +0.0089, p<0.001). However, GWR revealed that the magnitude of this harm follows a bimodal distribution. A "Compounded Risk" regime, with a strong link between deprivation and mortality, was identified in hospitals clustered in the Great Plains. In contrast, a "Mitigated Risk" regime with a much weaker association was found in other regions, including the Pacific Northwest. The relationship with PM2.5 was trimodal, unmasking a "Delta Paradox" of confounding in the Deep South and, most critically, a distinct environmental "hot spot" where higher PM2.5 was associated with a significant increase in mortality, clustered along the Southeastern Atlantic Seaboard.
Conclusions: The impact of community determinants on CABG outcomes is not a simple continuum but a set of distinct, geographically coherent regimes. Geographically blind risk models are insufficient, as they fail to capture critical, place-based drivers of surgical outcomes. Health policy aimed at improving surgical quality must be tailored to the unique social and environmental realities of the communities that hospitals serve.
Authors
Alyster Alcudia (1), Glade Adams (1), Aryan Gupta (1), Priya Joshi (1), Kristina Lowndes (1), Subodha Kumar (2), William Moser (3), Suyog Mokashi (3)
Institutions
(1) Lewis Katz School of Medicine at Temple University, Philadelphia, PA, (2) Fox School of Business at Temple University, Philadelphia, PA, (3) Temple University Hospital, Philadelphia, PA