Bergström Göran, Redfors Björn, Angerås Oskar, Dworeck Christian, Shao Yangzhen, Haraldsson Inger, Petursson Petur, Milicic Davor, Wedel Hans, Albertsson Per, Råmunddal Truls, Rosengren Annika, Omerovic Elmir
Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Int J Cardiol. 2015 Mar 1;182:141-7. doi: 10.1016/j.ijcard.2014.12.060. Epub 2014 Dec 23.
Previous studies have established a relationship between socioeconomic status (SES) and survival in coronary heart disease. Acute cardiac care in Sweden is considered to be excellent and independent of SES. We studied the influence of area-level socioeconomic status on mortality after hospitalization for acute myocardial infarction (AMI) between 1995 and 2013 in the Gothenburg metropolitan area, which has little over 800,000 inhabitants and includes three city hospitals.
Data were obtained from the SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and the Swedish Central Bureau of Statistics for patients hospitalized for ST-elevation myocardial infarction (STEMI) and non-STEMI in the city of Gothenburg in Western Sweden. The groups were compared using Cox proportional hazards regression and logistic regression.
10,895 (36% female) patients were hospitalized due to AMI during the study period. Patients residing in areas with lower SES had higher rates of smoking and diabetes (P<0.001), and were also at increased risk of developing complications, including heart failure and cardiogenic shock (P<0.05). Living in an area with lower SES associated with increased risk of dying after an AMI also in models adjusted for risk factors (P<0.05).
Also in a country with strong egalitarian traditions, lower SES associates with worse prognosis after AMI, an association that persists after adjustments for differences in traditional cardiovascular risk factors.
先前的研究已经确立了社会经济地位（SES）与冠心病存活率之间的关系。瑞典的急性心脏护理被认为非常出色，且与SES无关。我们研究了1995年至2013年期间，在哥德堡大都市区（人口略超80万，包括三家城市医院），地区层面的社会经济地位对急性心肌梗死（AMI）住院后死亡率的影响。
数据来自瑞典心脏病增强循证护理网络系统（SWEDEHEART注册中心）以及瑞典中央统计局，涉及瑞典西部哥德堡市因ST段抬高型心肌梗死（STEMI）和非STEMI住院的患者。使用Cox比例风险回归和逻辑回归对各组进行比较。
在研究期间，有10,895名（36%为女性）患者因AMI住院。居住在SES较低地区的患者吸烟率和糖尿病患病率更高（P<0.001），发生并发症（包括心力衰竭和心源性休克）的风险也更高（P<0.05）。在对风险因素进行调整的模型中，居住在SES较低地区也与AMI后死亡风险增加相关（P<0.05）。
即使在一个有着强烈平等主义传统的国家，较低的SES也与AMI后更差的预后相关，这种关联在对传统心血管风险因素差异进行调整后仍然存在。
