Effects of socioeconomic status on mortality after acute myocardial infarction
Effects of socioeconomic status on mortality after acute myocardial infarction
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DOI：
10.1016/j.amjmed.2006.05.056
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发表时间：
2007-01-01
影响因子：
5.9
通讯作者：
Armstrong, Paul W.
中科院分区：
文献类型：
--
作者：
Chang, Wei-Ching;Kaul, Padma;Armstrong, Paul W.
目的：评价社会经济状况对急性心肌梗死患者死亡率的影响。材料和方法：我们对1998年4月至2002年3月期间在加拿大阿尔伯塔省一家医院急诊室就诊的5622例急性心肌梗死患者进行了回顾性队列研究。我们的主要结局指标是指标急诊科就诊后的1年全因死亡率；在控制了患者和医院特征以及血运重建后，我们使用社会经济地位（由社区家庭收入中位数测量）作为主要预测因子。结果：社会经济状况深刻影响急诊科就诊率以及急性心肌梗死护理的过程和结果。在社会经济地位最低四分位数的患者与社会经济地位最高四分位数的患者中，到急诊室就诊的风险高出72% (P < 0.001)；1年时，血运重建率较低（36% vs 48%, P < 0.001），死亡率较高（19.1% vs 9.1%, P < 0.001）。经基线特征调整和1年血运重建术后，社会经济地位与1年死亡率独立相关，社会经济地位对非血运重建术患者影响尤大。结论：考虑到社会经济地位对急性心肌梗死后死亡率的影响以及血运重建在调节这一关系中的关键作用，我们的研究对心脏护理的可及性和过程具有重要意义。(c) 2007爱思唯尔公司版权所有。
PURPOSE: To assess the effects of socioeconomic status on mortality in patients with acute myocardial infarction.MATERIAL AND METHODS: We studied a retrospective cohort of 5622 patients who presented to a hospital emergency department with an initial episode of acute myocardial infarction between April 1998 and March 2002 in the Province of Alberta, Canada. Our main outcome measure was 1-year all-cause mortality following the index emergency department visit; we used socioeconomic status ( measured by neighborhood median household income) as our main predictor after controlling for patient and hospital characteristics and revascularization.RESULTS: Socioeconomic status profoundly affected the rate of emergency department presentation and the process and outcome of acute myocardial infarction care. In patients belonging to the lowest versus the highest socioeconomic status quartile, the risk of presenting to the emergency department was 72% higher ( P < .001); at 1 year, revascularization was lower ( 36% vs 48%, P < .001), and mortality higher ( 19.1% vs 9.1%, P < .001). Socioeconomic status was independently associated with 1-year mortality after adjustment for baseline characteristics and 1- year revascularization, and socioeconomic status was especially influential in non-revascularized patients.CONCLUSIONS: Given the influence of socioeconomic status on mortality after acute myocardial infarction and the key role of revascularization in modulating this relationship, our study has important implications for access to and process of cardiac care. (c) 2007 Elsevier Inc. All rights reserved.