PROGNOSTIC IMPORTANCE OF SOCIAL AND ECONOMIC-RESOURCES AMONG MEDICALLY TREATED PATIENTS WITH ANGIOGRAPHICALLY DOCUMENTED CORONARY-ARTERY DISEASE
PROGNOSTIC IMPORTANCE OF SOCIAL AND ECONOMIC-RESOURCES AMONG MEDICALLY TREATED PATIENTS WITH ANGIOGRAPHICALLY DOCUMENTED CORONARY-ARTERY DISEASE
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DOI：
10.1001/jama.267.4.520
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发表时间：
1992-01-22
影响因子：
120.7
通讯作者：
MARK, DB
中科院分区：
文献类型：
--
作者：
WILLIAMS, RB;BAREFOOT, JC;MARK, DB
Objective. - 评估社会和经济资源减少对冠心病患者心血管死亡率产生不利影响的假设。- 对1974年至1980年接受心导管插入术并随访至1989年的患者进行的初始队列研究。- 三级护理大学医学中心。- 1965例至少一条主要冠状动脉狭窄≥ 75%的药物治疗患者的对比样本。500例患者因逻辑问题未入组; 33例拒绝入组; 64例关键医学变量数据缺失。最终研究人群包括1368名患者，82%为男性，中位年龄为52岁。- 至心血管死亡的生存时间。- 独立于所有已知的基线侵入性和非侵入性医学预后因素，家庭年收入≥ 40000美元的患者未校正的5年生存率为0.91，而收入≤ 10000美元的患者为0.76（考克斯模型校正的风险比为1.9; 95%置信区间为1.57 ~ 2.32; P = 0.002）。同样地，没有知己的未婚患者的未经校正的5年生存率为0.50，而已婚、有知己或两者兼而有之的患者的未经校正的5年生存率为0.82（校正的风险比为3.34; 95%可信区间为1.84 ~ 6.20; P <0.0001）。- 低水平的社会和经济资源在接受药物治疗的冠状动脉疾病患者中确定了一个重要的高危人群，独立于重要的医学预后因素。需要进一步研究，以确定增加这些资源的干预措施是否能改善预后。
Objective. - To evaluate the hypothesis that diminished social and economic resources impact adversely on cardiovascular mortality in patients with coronary artery disease.Design. - Inception cohort study of patients undergoing cardiac catheterization from 1974 through 1980 and followed up through 1989.Setting. - Tertiary care university medical center.Patients. - Consecutive sample of 1965 medically treated patients with stenosis 75% or greater of at least one major coronary artery. Five hundred patients were not enrolled due to logistic problems; 33 refused; 64 had missing data on key medical variables. The final study population included 1368 patients, 82% male, with a median age of 52 years.Main Outcome Measure. - Survival time until cardiovascular death.Results. - Independent of all known baseline invasive and noninvasive medical prognostic factors, patients with annual household incomes of $40 000 or more had an unadjusted 5-year survival of 0.91, compared with 0.76 in patients with incomes of $10 000 or less (Cox model adjusted hazard ratio, 1.9; 95% confidence interval, 1.57 to 2.32; P = .002). Similarly, unmarried patients without a confidant had an unadjusted 5-year survival rate of 0.50, compared with 0.82 in patients who were married, had a confidant, or both (adjusted hazard ratio, 3.34; 95% confidence interval, 1.84 to 6.20; P < .0001).Conclusions. - Low levels of social and economic resources identify an important high-risk group among medically treated patients with coronary artery disease, independent of important medical prognostic factors. Additional study will be required to see if interventions to increase these resources improve prognosis.