Picciotto Sally, Forastiere Francesco, Stafoggia Massimo, D'Ippoliti Daniela, Ancona Carla, Perucci Carlo A
Dipartimento di Epidemiologia, ASL RM/E, Via di Santa Costanza, 53, 00198 Roma, Italy.
J Epidemiol Community Health. 2006 Jan;60(1):37-43. doi: 10.1136/jech.2005.037846.
Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender.
Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n=3470) or were hospitalised for first acute myocardial infarction (n=8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation.
Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR=1.40, 95%CI:1.30, 1.50, women RR=1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR=0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR=0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes.
Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.
心肌梗死发生中的社会经济梯度已为人熟知,但很少有研究考察心肌梗死后转归的社会经济差异。本研究的目的是探讨1998 - 2000年期间意大利罗马社会经济地位与首次冠心病事件的发病率、治疗及转归之间的关系,并检验性别对效应的修正作用。
研究对象为35 - 84岁的罗马居民,这些居民在到达医院前死于首次急性冠脉事件(n = 3470)或因首次急性心肌梗死住院(n = 8467)。基于区域的贫困状况和患者的教育程度为暴露变量。转归包括:冠脉事件的发病率;首次住院时的再灌注以及住院28天内的死亡率;首次住院28天至1年期间的心脏再入院率和死亡率。
发病率随基于区域的贫困状况增加而升高;女性的这种效应强于男性(男性相对危险度RR = 1.40,95%可信区间CI:1.30, 1.50;女性RR = 1.78,95%CI:1.60, 1.98,最贫困组与最不贫困组相比)。最贫困患者的再灌注率显著低于最不贫困患者(比值比OR = 0.77,95%CI:0.59, 0.99),受教育程度低的患者低于受教育程度高的患者(OR = 0.73,95%CI:0.58, 0.90)。短期死亡率与基于区域的贫困状况和教育程度的关联较弱且不一致。然而,贫困状况和教育程度均与1年转归无关。
基于区域的贫困状况与冠脉事件的发病率密切相关,女性更为明显。贫困状况和教育程度与短期死亡率的关联较弱且不一致,但似乎不影响急性心肌梗死的1年预后。贫困和受教育程度低的患者接受再灌注治疗的机会有限。