Abstract
OBJECTIVE—To examine the influence of socioeconomic deprivation on case fatality following acute myocardial infarction. DESIGN—Prospective cohort observational study. SETTING—General hospital. PATIENTS—1417 white and south Asian patients admitted with acute myocardial infarction between January 1988 and December 1996, and classified by the Carstairs socioeconomic deprivation score of the enumeration district of residence. MAIN OUTCOME MEASURES—30 day and one year survival. RESULTS—There was little variation across deprivation groups in age, sex, or smoking status, though a higher proportion of patients from more deprived enumeration districts were diabetic and of south Asian origin, and a higher proportion of them developed Q wave infarction and left ventricular failure. There was no appreciable variation in clinical treatment with deprivation. Patients from more deprived enumeration districts had a higher risk of recurrent ischaemic events (death, recurrent myocardial infarction, or unstable angina) over the first 30 days: event free survival (95% confidence interval (CI)) of the most deprived quartile was 0.79 (95% CI 0.74 to 0.83) compared with 0.85 (95% CI 0.80 to 0.88) in the least deprived quartile. The unadjusted hazard ratio corresponding to an increase from the 5th to 95th centile of the deprivation distribution was 1.54 (95% CI 1.02 to 2.32), and 1.59 (95% CI 1.03 to 2.44) after adjustment for age, sex, racial group, diabetes, acute treatment with thrombolysis and aspirin, and left ventricular failure. Survival from 30 days to one year, however, did not show a socioeconomic gradient (hazard ratio adjusted for the same variables was 1.07 (95% CI 0.68 to 1.70)). CONCLUSIONS—In patients hospitalised with acute myocardial infarction, there is a strong association between early recurrent ischaemic events and socioeconomic deprivation that is not accounted for by clinical presentation or treatment. This association appears to be attenuated over time. Keywords: acute myocardial infarction; socieconomic deprivation; survival
Full Text
The Full Text of this article is available as a PDF (115.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Capewell S., Kendrick S., Boyd J., Cohen G., Juszczak E., Clarke J. Measuring outcomes: one month survival after acute myocardial infarction in Scotland. Heart. 1996 Jul;76(1):70–75. doi: 10.1136/hrt.76.1.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985 Jan-Mar;4(1):87–90. doi: 10.1002/sim.4780040112. [DOI] [PubMed] [Google Scholar]
- Hammar N., Alfredsson L., Smedberg M., Ahlbom A. Differences in the incidence of myocardial infarction among occupational groups. Scand J Work Environ Health. 1992 Jun;18(3):178–185. doi: 10.5271/sjweh.1590. [DOI] [PubMed] [Google Scholar]
- Hawthorne V. M., Watt G. C., Hart C. L., Hole D. J., Smith G. D., Gillis C. R. Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (midspan) study population. Scott Med J. 1995 Aug;40(4):102–107. doi: 10.1177/003693309504000402. [DOI] [PubMed] [Google Scholar]
- Hebert P. R., Buring J. E., O'Connor G. T., Rosner B., Hennekens C. H. Occupation and risk of nonfatal myocardial infarction. Arch Intern Med. 1992 Nov;152(11):2253–2257. [PubMed] [Google Scholar]
- Holme I., Helgeland A., Hjermann I., Leren P., Lund-Larsen P. G. Four-year mortality by some socioeconomic indicators: the Oslo study. J Epidemiol Community Health. 1980 Mar;34(1):48–52. doi: 10.1136/jech.34.1.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marmot M. G., McDowall M. E. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. doi: 10.1016/s0140-6736(86)92085-4. [DOI] [PubMed] [Google Scholar]
- Marmot M. G., Shipley M. J., Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. doi: 10.1016/s0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
- Morrison C., Woodward M., Leslie W., Tunstall-Pedoe H. Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997 Feb 22;314(7080):541–546. doi: 10.1136/bmj.314.7080.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pearce N. E., Davis P. B., Smith A. H., Foster F. H. Mortality and social class in New Zealand II: male mortality by major disease groupings. N Z Med J. 1983 Sep 28;96(740):711–716. [PubMed] [Google Scholar]
- Rosengren A., Wedel H., Wilhelmsen L. Coronary heart disease and mortality in middle aged men from different occupational classes in Sweden. BMJ. 1988 Dec 10;297(6662):1497–1500. doi: 10.1136/bmj.297.6662.1497. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ruberman W. Psychosocial influences on mortality of patients with coronary heart disease. JAMA. 1992 Jan 22;267(4):559–560. [PubMed] [Google Scholar]
- Schettler G. Atherosclerosis during periods of food deprivation following World Wars I and II. Prev Med. 1983 Jan;12(1):75–83. doi: 10.1016/0091-7435(83)90174-3. [DOI] [PubMed] [Google Scholar]
- Smith G. D., Shipley M. J., Rose G. Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study. J Epidemiol Community Health. 1990 Dec;44(4):265–270. doi: 10.1136/jech.44.4.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith W. C., Kenicer M. B., Tunstall-Pedoe H., Clark E. C., Crombie I. K. Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study. Br Heart J. 1990 Nov;64(5):295–298. doi: 10.1136/hrt.64.5.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stevenson R., Ranjadayalan K., Wilkinson P., Roberts R., Timmis A. D. Short and long term prognosis of acute myocardial infarction since introduction of thrombolysis. BMJ. 1993 Aug 7;307(6900):349–353. doi: 10.1136/bmj.307.6900.349. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tofler G. H., Muller J. E., Stone P. H., Davies G., Davis V. G., Braunwald E. Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Multicenter Investigation of the Limitation of Infarct Size (MILIS). Am J Cardiol. 1993 May 1;71(12):1031–1035. doi: 10.1016/0002-9149(93)90568-w. [DOI] [PubMed] [Google Scholar]
- Wilhelmsen L., Rosengren A. Are there socio-economic differences in survival after acute myocardial infarction? Eur Heart J. 1996 Nov;17(11):1619–1623. doi: 10.1093/oxfordjournals.eurheartj.a014743. [DOI] [PubMed] [Google Scholar]
- Wilkinson P., Sayer J., Laji K., Grundy C., Marchant B., Kopelman P., Timmis A. D. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. BMJ. 1996 May 25;312(7042):1330–1333. doi: 10.1136/bmj.312.7042.1330. [DOI] [PMC free article] [PubMed] [Google Scholar]