Cacciani Laura, Agabiti Nera, Bargagli Anna Maria, Davoli Marina
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
PLoS One. 2017 Apr 6;12(4):e0175038. doi: 10.1371/journal.pone.0175038. eCollection 2017.
Socioeconomic status and gender are associated with access to cardiac procedures and mortality after AMI, also in countries with universal health care systems. Our objective was to evaluate the association and trends of educational level or gender and the following outcomes: 1) access to PTCA; 2) 30-day mortality.
We conducted an observational study based on 14,013 subjects aged 35-74 years, residing in Rome in 2001, and hospitalised for incident STEMI within 2012 in the Lazio region. We estimated adjusted ORs of educational level or gender and: 1) PTCA within 2 days after hospitalisation, 2) 30-day mortality. We evaluated time trends of outcomes, and time trends of educational or gender differentials estimating ORs stratified by time period (two time periods between 2001 and 2012). We performed a hierarchical analysis to account for clustering of hospitals.
Access to PTCA among patients with incident STEMI increased during the study period, while 30-day mortality was stable. We observed educational differentials in PTCA procedure only in the first time period, and gender differentials in both periods. Patterns for 30-day mortality were less marked, with educational differentials emerging only in the second period, and gender differentials only in the first one, with patients with low educational level and females being disadvantaged.
Educational differentials in the access to PTCA disappeared in Lazio region over time, coherently with scientific literature, while gender differentials seem to persist. It may be important to assess the role of female gender in patients with STEMI, both from a social and a clinical point of view.
在拥有全民医疗保健系统的国家，社会经济地位和性别与急性心肌梗死后接受心脏手术的机会及死亡率相关。我们的目的是评估教育水平或性别与以下结果之间的关联及趋势：1）接受经皮冠状动脉腔内血管成形术（PTCA）的机会；2）30天死亡率。
我们基于2001年居住在罗马、年龄在35 - 74岁且于2012年在拉齐奥地区因首次发生ST段抬高型心肌梗死（STEMI）而住院的14,013名受试者进行了一项观察性研究。我们估计了教育水平或性别的校正比值比（OR）以及：1）住院后2天内接受PTCA的情况；2）30天死亡率。我们评估了结果的时间趋势，以及按时间段（2001年至2012年之间的两个时间段）分层估计OR的教育或性别差异的时间趋势。我们进行了分层分析以考虑医院的聚类情况。
在研究期间，首次发生STEMI的患者接受PTCA的机会增加，而30天死亡率保持稳定。我们仅在第一个时间段观察到PTCA手术中的教育差异，在两个时间段均观察到性别差异。30天死亡率的模式不太明显，教育差异仅在第二个时间段出现，性别差异仅在第一个时间段出现，低教育水平患者和女性处于不利地位。
随着时间的推移，拉齐奥地区接受PTCA的教育差异与科学文献一致消失，而性别差异似乎仍然存在。从社会和临床角度评估女性性别在STEMI患者中的作用可能很重要。
