Socioeconomic status and mortality after acute myocardial infarction
Socioeconomic status and mortality after acute myocardial infarction
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DOI：
10.7326/0003-4819-144-2-200601170-00005
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发表时间：
2006-01-17
影响因子：
39.2
通讯作者：
Naylor, CD
中科院分区：
文献类型：
--
作者：
Alter, DA;Chong, A;Naylor, CD
背景：在许多人群中观察到了将社会经济地位与心血管死亡率联系起来的梯度，包括那些提供公共资助的全面医疗保险的国家。目的：研究社会经济状况、其他健康因素和急性心肌梗死(MI)后两年死亡率之间的关系。设计：前瞻性队列研究。地点：加拿大安大略省。患者：1999年12月至2003年2月在加拿大53家大型医院因急性心肌梗死住院的3407名患者。测量：作者获得了自我报告的收入和教育程度测量，并制定了患者入院前的心脏风险和合并情况的档案。为了创建这些档案，作者使用了患者的自我报告，并回顾了至少12年的住院数据。在对年龄、性别、种族、社会支持、心血管病史和风险、共病情况以及选定的住院过程因素进行序贯风险调整的情况下和不进行序贯风险调整的情况下，对急性心肌梗塞后2年的死亡率进行了检查。结果：收入与2年死亡率显著负相关(高收入与低收入三分位数的粗风险比，0.45[95%CI，0.35至0.57]；P<；0.001)。然而，在调整了年龄和既往心血管事件或常规血管危险因素后，收入的影响大大减弱(调整后的高收入与低收入三分位数的风险比，0.77[CI，0.54to1.10]；P=0.150)。非心血管合并症和住院过程因素的解释作用微乎其微。限制：以往的心血管风险通过自我报告或通过纵向跟踪医院的管理数据库来确定。这项研究开始于一组有指标性心脏事件的患者，而不是无症状的个体。结论：年龄、既往心血管事件和当前的血管危险因素是急性心肌梗死后收入-死亡率梯度的主要原因。这一观察表明，通过对不太富裕的人中已知的风险因素进行更严格的管理，心血管死亡率的“财富-健康梯度”可能会得到部分改善。
Background: Gradients that link socioeconomic status and cardiovascular mortality have been observed in many populations, including those of countries that provide publicly funded comprehensive medical coverage. The intermediary causes of such gradients remain poorly elucidated.Objective: To examine the relationships among socioeconomic status, other health factors, and 2-year mortality rates after acute myocardial infarction (MI).Design: Prospective cohort study.Setting: Ontario, Canada. Patients: 3407 patients who were hospitalized for acute MI in 53 large-volume hospitals in Canada from December 1999 to February 2003.Measurements: The authors obtained self-reported measures of income and education and developed profiles of the patients' pre-hospitalization cardiac risks and comorbid conditions. To create these profiles, the authors used the patients' self-reports and retrospectively linked no less than 12 years' worth of previous hospitalization data. Mortality rates 2 years after acute MI were examined with and without sequential risk adjustment for age, sex, ethnicity, social support, cardiovascular history and risk, comorbid conditions, and selected in-hospital process factors.Results: Income was strongly and inversely correlated with 2-year mortality rate (crude hazard ratio for high-income vs. low-income tertile, 0.45 [95% Cl, 0.35 to 0.57); P < 0.001). However, after adjustment for age and preexisting cardiovascular events or conventional vascular risk factors, the effect of income was greatly attenuated (adjusted hazard ratio for high-income vs. low-income tertile, 0.77 [CI, 0.54 to 1.10]; P = 0.150). Noncardiovascular comorbid conditions and in-hospital process factors had negligible explanatory effect.Limitations: Previous cardiovascular risks were ascertained through self-report or retrospectively through the longitudinal tracking of the hospitals' administrative databases. The study began with a cohort of patients who had an index cardiac event rather than with asymptomatic individuals.Conclusions: Age, past cardiovascular events, and current vascular risk factors accounted for most of the income-mortality gradient after acute MI. This observation suggests that the "wealth-health gradient" in cardiovascular mortality may be partially ameliorated by more rigorous management of known risk factors among less affluent persons.