Abbasi Seyed Hesameddin, De Leon Antonio Ponce, Kassaian Seyed Ebrahim, Karimi Abbasali, Sundin Örjan, Jalali Arash, Soares Joaquim, Macassa Gloria
Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden ; Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of Heart, Family Health Research Center, Iranian Petroleum Health Research Institute, Tehran, Iran.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Department o de Epidemiologia, Instituto de Medicina Social, Universidade do Estado de Rio de Janeiro, Brazil.
Int J Prev Med. 2015 May 4;6:36. doi: 10.4103/2008-7802.156266. eCollection 2015.
Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in-hospital mortality of patients with the acute coronary syndrome (ACS) according to their SES.
All patients admitted to Tehran Heart Center due to 1(st)-time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low-SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high-SES patients. Demographic, clinical, paraclinical, and in-hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in-hospital mortality was evaluated.
A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low-SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in-hospital mortality of the ACS patients in that the high-SES patients had a lower in-hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094-0.980; P = 0.046).
This study found that patients with low SES were at a higher risk of in-hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.
社会经济地位（SES）会极大地影响医疗问题的临床结局。我们试图根据急性冠状动脉综合征（ACS）患者的SES评估其住院死亡率。
对2004年3月至2011年8月期间因首次ACS入住德黑兰心脏中心的所有患者进行评估。文盲/低学历（受教育年限≤5年）且失业的患者被视为低SES患者，而就业且高学历（受教育年限>5年）的患者被视为高SES患者。记录人口统计学、临床、辅助检查和住院期间医疗进展数据。将住院期间死亡视为终点，评估SES对住院死亡率的影响。
共纳入6246例住院患者（低SES组3290例，高SES组2956例）（平均年龄=60.3±12.1岁，男性2772例[44.4%]）。其中，79例（1.26%）患者死亡。单因素分析显示低SES组死亡率显著更高（1.9%对0.6%；P<0.001）。在对可能的混杂因素进行调整后，SES对ACS患者的住院死亡率仍有显著影响，高SES患者的住院死亡率较低（优势比：0.304，95%置信区间：0.094-0.980；P=0.046）。
本研究发现，低SES患者因ACS导致的住院死亡风险更高。此外，结果表明需要增加就业机会以及提高教育水平，作为预防措施以遏制因冠状动脉综合征导致的死亡。
