Tetzlaff Juliane, Geyer Siegfried, Westhoff-Bleck Mechthild, Sperlich Stefanie, Epping Jelena, Tetzlaff Fabian
Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany.
BMC Public Health. 2021 Feb 1;21(1):259. doi: 10.1186/s12889-021-10236-7.
Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI.
The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations.
During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups.
Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.
急性心肌梗死（MI）仍是一种常见的健康事件，也是全球长期功能障碍的主要原因。到目前为止，关于MI发病率和死亡率方面社会不平等与MI严重程度关系的研究有限。此外，缺乏关于MI对寿命影响差异的证据。本研究调查了MI发病率、死亡率以及无MI的生命年数、受轻度或重度MI后果影响的生命年数方面的社会不平等情况。
本研究基于一家大型德国法定健康保险提供商2008年至2017年的数据（N = 1,253,083）。使用多状态分析方法分析MI发病率、死亡率风险以及轻度或重度MI和无MI情况下生命年数的收入不平等情况。MI严重程度的评估基于诊断出的导致身体功能受限的心力衰竭情况。
在研究期间，共发生39,832例轻度MI、22,844例重度MI、276,582例无MI死亡、15,120例轻度MI后死亡和16,495例重度MI后死亡。在MI发病率和死亡率方面发现了明显的不平等，在男性中以及重度MI发病率方面最为明显。此外，在无MI的生命年数方面，男女均存在显著不平等，低收入者处于劣势，而高收入男性在轻度MI后的生命年数有所增加。重度MI后的生命年数在各收入组中相似。
MI发病率和死亡率风险方面的社会不平等导致无MI生命年数存在明显差异，低收入男性处于最不利地位。我们的研究结果强调了一级和二级预防的重要性，尤其应关注社会弱势群体。
