社会经济地位与老年人急性心肌梗死后短期死亡率之间的关系仍然存在：一项全国性研究的结果。
The relation between socioeconomic status and short-term mortality after acute myocardial infarction persists in the elderly: results from a nationwide study.
机构信息
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Eur J Epidemiol. 2012 Aug;27(8):605-13. doi: 10.1007/s10654-012-9700-z. Epub 2012 Jun 5.
We assessed whether the previously observed relationship between socioeconomic status (SES) and short-term mortality (pre-hospital mortality and 28-day case-fatality) after a first acute myocardial infarction (AMI) in persons <75 years, are also observed in the elderly (i.e. ≥75 years), and whether these relationships vary by sex. A nationwide register based cohort study was conducted. Between January 1st 1998 and December 31st 2007, 76,351 first AMI patients were identified, of whom 60,498 (79.2 %) were hospitalized. Logistic regression analyses were performed to measure SES differences in pre-hospital mortality after a first AMI and 28-day case-fatality after a first AMI hospitalization. All analyses were stratified by sex and age group (<55, 55-64, 65-74, 75-84, ≥85), and adjusted for age, ethnic origin, marital status, and degree of urbanization. There was an inverse relation between SES and pre-hospital mortality in both sexes. There was also an inverse relation between SES and 28-day case-fatality after hospitalization, but only in men. Compared to elderly men with the highest SES, elderly men with the lowest SES had a higher pre-hospital mortality in both 75-84 year-olds (OR = 1.26; 95 % CI 1.09-1.47) and ≥85 year-olds (OR = 1.26; 1.00-1.58), and a higher 28-day case-fatality in both 75-84 year-olds (OR = 1.26; 1.06-1.50) and ≥85 year-olds (OR = 1.36; 0.99-1.85). Compared to elderly women with the highest SES, elderly women with the lowest SES had a higher pre-hospital mortality in ≥85 year-olds (OR = 1.20; 0.99-1.46). To conclude, in men there are SES inequalities in both pre-hospital mortality and case-fatality after a first AMI, in women these SES inequalities are only shown in pre-hospital mortality. The inequalities persist in the elderly (≥75 years of age). Clinicians and policymakers need to be more vigilant on the population with a low SES background, including the elderly.
我们评估了在年龄小于 75 岁的人群中，社会经济地位（SES）与首次急性心肌梗死（AMI）后短期死亡率（院前死亡率和 28 天病死率）之间的先前观察到的关系，是否也存在于老年人（即≥75 岁）中，以及这些关系是否因性别而异。进行了一项全国范围内的基于登记的队列研究。在 1998 年 1 月 1 日至 2007 年 12 月 31 日期间，确定了 76351 名首次 AMI 患者，其中 60498 名（79.2%）住院。进行逻辑回归分析以衡量首次 AMI 后的 SES 差异与首次 AMI 住院后的 28 天病死率之间的关系。所有分析均按性别和年龄组（<55 岁、55-64 岁、65-74 岁、75-84 岁、≥85 岁）分层，并根据年龄、种族、婚姻状况和城市化程度进行调整。SES 与两性的院前死亡率呈负相关。SES 与住院后 28 天病死率也呈负相关，但仅在男性中。与 SES 最高的老年男性相比，SES 最低的老年男性在 75-84 岁（OR=1.26；95%CI 1.09-1.47）和≥85 岁（OR=1.26；1.00-1.58）的院前死亡率更高，在 75-84 岁（OR=1.26；1.06-1.50）和≥85 岁（OR=1.36；0.99-1.85）的 28 天病死率也更高。与 SES 最高的老年女性相比，SES 最低的老年女性在≥85 岁的院前死亡率更高（OR=1.20；0.99-1.46）。总之，在男性中，SES 在首次 AMI 后的院前死亡率和病死率方面存在不平等现象，而在女性中，这些 SES 不平等现象仅表现在院前死亡率方面。这些不平等现象在老年人（≥75 岁）中仍然存在。临床医生和决策者需要对 SES 背景较低的人群（包括老年人）更加警惕。
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