1 Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.
2 Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2019 Mar 19;8(6):e011490. doi: 10.1161/JAHA.118.011490.
Background Little is known of the impact of social factors on mortality after coronary artery bypass grafting ( CABG ). We explored sex- and age-specific associations between mortality risk after CABG and marital status, income, and education. Methods and Results This population-based register study included 110 742 CABG patients (21.3% women) from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies) operated 1992 to 2015. Cox regression models were used to study the relation between social factors and all-cause mortality. Never having been married compared with being married/cohabiting was associated with a higher risk in women than in men (hazard ratio 1.32, 95% CI 1.20-1.44) versus 1.17 (1.13-1.22), P=0.030 between sex. The lowest income quintile, compared with the highest, was associated with higher risk in men than in women (hazard ratio 1.44 [1.38-1.51] versus 1.25 [1.14-1.38], P=0.0036). Lowest education level was associated with higher risk without sex difference (hazard ratio 1.15 [1.11-1.19] versus 1.25 [1.16-1.35], P=0.75). For unmarried women aged 60 years at surgery with low income and low education, mortality 10 years after surgery was 18%, compared with 11% in married women with high income and higher education level. The median life expectancy was 4.8 years shorter. Corresponding figures for 60-year-old men were 21% versus 12% mortality risk at 10 years and 5.0 years shorter life expectancy. Conclusions There are strong associations between social factors and mortality risk after CABG in both men and women. These results emphasize the importance of developing and implementing secondary prevention strategies for CABG patients with disadvantages in social factors.
对于冠状动脉旁路移植术（CABG）后死亡率的影响，社会因素知之甚少。我们探讨了 CABG 后死亡率与婚姻状况、收入和教育程度之间的性别和年龄特异性关联。
本项基于人群的登记研究纳入了 1992 年至 2015 年期间来自 SWEDEHEART 登记处（瑞典基于证据的心脏病治疗增强和开发网络系统）的 110742 名 CABG 患者（21.3%为女性）。Cox 回归模型用于研究社会因素与全因死亡率之间的关系。与已婚/同居相比，从未结婚的女性的风险高于男性（危险比 1.32，95%CI 1.20-1.44），而男性的风险比为 1.17（1.13-1.22），性别之间存在差异（P=0.030）。与收入最高的五分位数相比，收入最低的五分位数与男性的风险增加相关，而与女性的风险增加相关（危险比 1.44[1.38-1.51]与 1.25[1.14-1.38]，P=0.0036）。低教育水平与无性别差异的高风险相关（危险比 1.15[1.11-1.19]与 1.25[1.16-1.35]，P=0.75）。对于手术时年龄为 60 岁的未婚女性，收入低且教育程度低，手术后 10 年的死亡率为 18%，而收入高且教育程度高的已婚女性为 11%。中位预期寿命缩短了 4.8 年。对于 60 岁的男性，10 年的死亡率风险分别为 21%和 12%，预期寿命缩短 5.0 年。
在男性和女性中，社会因素与 CABG 后死亡率之间存在很强的关联。这些结果强调了为 CABG 患者制定和实施二级预防策略的重要性，这些患者在社会因素方面处于劣势。
