Chan Raymond H M, Gordon Neil F, Chong Alice, Alter David A
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
Am J Cardiol. 2008 Dec 15;102(12):1583-8. doi: 10.1016/j.amjcard.2008.08.022. Epub 2008 Oct 9.
The impact of secondary prevention initiatives on survival in higher-risk socioeconomically disadvantaged patients after acute myocardial infarction (AMI) may depend on behavioral adaptive responsiveness, uptake, and adherence to healthier lifestyles. From December 1999 to February 2003, 1,801 patients in Ontario, Canada were interviewed regarding their lifestyle behaviors at 30 days after their index AMI hospitalization. Data were obtained using self-reported surveys, medical chart abstraction, and administrative data linkage. Multivariate analyses were adjusted for baseline sociodemographic, cardiac risk severity, and co-morbid conditions. Socioeconomically disadvantaged patients had greater cardiac risk severity at baseline than did their wealthier better-educated counterparts. Compared with lower-income patients, patients with higher incomes were less likely to smoke (adjusted odds ratio [OR] for highest vs lowest income tertiles 0.36, 95% confidence interval [CI] 0.21 to 0.63, p <0.001), more likely to participate in exercise (adjusted OR 1.40, 95% CI 1.07 to 1.85, p = 0.02), and more likely to decrease or discontinue alcohol use (adjusted OR 1.64, 95% CI 1.16 to 2.34, p = 0.06). The relation between education and lifestyle behaviors was less pronounced for education than for income. After adjustment for baseline factors, patients who acknowledged participation in regular physical exercise at 1 month had a significantly lower long-term mortality than those who did not. In conclusion, socioeconomically disadvantaged patients were sicker at baseline and less behaviorally responsive to embarking on healthy lifestyle changes after AMI than were those of higher socioeconomic status.
二级预防措施对急性心肌梗死（AMI）后社会经济地位不利的高危患者生存率的影响可能取决于行为适应性反应、接受程度以及对更健康生活方式的坚持。1999年12月至2003年2月，对加拿大安大略省的1801名患者在首次AMI住院30天后的生活方式行为进行了访谈。数据通过自我报告调查、病历摘要和行政数据链接获得。多变量分析对基线社会人口统计学、心脏风险严重程度和合并症进行了调整。社会经济地位不利的患者在基线时的心脏风险严重程度高于社会经济地位较高、受教育程度较好的患者。与低收入患者相比，高收入患者吸烟的可能性较小（最高收入三分位数与最低收入三分位数的调整优势比[OR]为0.36，95%置信区间[CI]为0.21至0.63，p<0.001），参加锻炼的可能性较大（调整OR为1.40，95%CI为1.07至1.85，p=0.02），减少或戒酒的可能性较大（调整OR为1.64，95%CI为1.16至2.34，p=0.06）。教育与生活方式行为之间的关系在教育方面不如在收入方面明显。在对基线因素进行调整后，在1个月时承认参加定期体育锻炼的患者的长期死亡率明显低于未参加的患者。总之，社会经济地位不利的患者在基线时病情较重，与社会经济地位较高的患者相比，AMI后对开始健康生活方式改变的行为反应较小。
