Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
Eur J Public Health. 2018 Dec 1;28(6):1103-1109. doi: 10.1093/eurpub/cky075.
Preventing ischaemic stroke attracts significant focus in atrial fibrillation (AF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF.
Our study population included adults (n=12 283) ≥45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions.
During a mean of 5.8 years (SD 2.4) of follow-up, 3954 (32.3%) patients had died; 1971 were women (35.0%) and 1983 were men (29.8%). Higher educational level was associated with a reduced mortality in fully adjusted models: HR 0.85 (95% CI 0.77-0.96) for secondary school in men, HR 0.73 (95% CI 0.60-0.88) for college/university in women, and HR 0.82 (95% CI 0.71-0.94) for college/university in men, compared to primary school. Unmarried men and divorced men had an increased risk of death, compared with married men: HR 1.25 (95% CI 1.05-1.50), and HR 1.23 (95% CI 1.07-1.42), respectively. College/university education level was also associated with lower risk of myocardial infarction in men and women, and lower risk of congestive heart failure in women.
More attention could be paid to individuals of lower levels of formal education, and unmarried men, in order to provide timely management for AF and prevent its debilitating complications.
预防缺血性中风是房颤（AF）患者关注的焦点。然而，社会经济因素与 AF 患者的死亡率和心血管结局之间的关系知之甚少。
我们的研究人群包括 2001 年至 2007 年在瑞典 75 个初级保健中心诊断为 AF 的≥45 岁成年人（n=12283）。使用 Cox 回归计算暴露于教育程度、婚姻状况、邻里社会经济状况与结局（全因死亡率）之间的风险比（HR）及其 95%置信区间（CI），并根据年龄和合并的心血管疾病进行调整。
在平均 5.8 年（SD 2.4）的随访期间，3954 名（32.3%）患者死亡；1971 名女性（35.0%），1983 名男性（29.8%）。在完全调整模型中，较高的教育程度与死亡率降低相关：男性中学程度的 HR 为 0.85（95%CI 0.77-0.96），女性大学/大专程度的 HR 为 0.73（95%CI 0.60-0.88），男性大学/大专程度的 HR 为 0.82（95%CI 0.71-0.94），与小学程度相比。与已婚男性相比，未婚男性和离婚男性的死亡风险增加：HR 分别为 1.25（95%CI 1.05-1.50）和 1.23（95%CI 1.07-1.42）。大学/大专教育程度也与男性和女性心肌梗死风险降低以及女性充血性心力衰竭风险降低相关。
应更加关注教育程度较低的个体和未婚男性，以便及时管理 AF 并预防其致残性并发症。
