Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark.
Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark.
Cardiovasc Revasc Med. 2023 Nov;56:64-72. doi: 10.1016/j.carrev.2023.05.012. Epub 2023 May 20.
Socioeconomic factors are well-established determinants of clinical outcomes among patients with acute coronary syndrome (ACS) although quality of care has improved the last decades. This study aims to investigate 20-years temporal trends of socioeconomic disparity in 1-year incidence of major adverse cardiac events (MACE) among ACS patients in Denmark.
This population-based cohort study included all incident ACS patients in the Danish National Patient Registry during 1998-2017. Socioeconomic disparity was assessed by income and educational level. Patients were followed 1-year for MACE; defined as all-cause mortality, recurrent ACS, revascularization, stroke, or cardiac arrest. Adjusted MACE incidence rates (aIR) and hazard rate ratios (aHR) were computed with 95 % confidence intervals (CI) for five-year-periods. Changes in trends were examined from interaction analyses between the HR for five-year-periods and income and education, respectively.
The study included 220,887 patients with first-time ACS. The incidence of MACE decreased within all income and education levels. In 1998-2002 the MACE aIR among patients with low income was 885[95%CI:863-907] versus 733[711-756]/1000-person-year among those with high income (aHR: 1.19[95%CI:1.15-1.23]). The aIRs decreased to 506[489-522] and 405[388-423]/1000-person-year, respectively, in 2013-2017 (aHR: 1.23[1.17-1.29]). The aIRs of MACE decreased correspondingly within all educational levels from 1998 to 2002 to 2013-2017. However, the socioeconomic disparity according to the interaction analyses persisted both according to income and educational level.
Although 1-year clinical outcomes following ACS has improved substantially over the last decades, socioeconomic disparity persisted both according to income and education level.
社会经济因素是急性冠状动脉综合征（ACS）患者临床结局的重要决定因素，尽管在过去几十年中，医疗质量已经有所改善。本研究旨在调查丹麦 ACS 患者在过去 20 年中，主要不良心脏事件（MACE）的 1 年发生率的社会经济差异的时间趋势。
本基于人群的队列研究纳入了 1998-2017 年期间丹麦国家患者登记处所有初次 ACS 患者。社会经济差异通过收入和教育水平来评估。患者在随访的 1 年内，评估 MACE 的发生情况，定义为全因死亡率、ACS 再发、血运重建、卒中和心脏骤停。使用 95%置信区间（CI）计算 5 年期间的调整后 MACE 发生率（aIR）和危险比（aHR）。通过 HR 与收入和教育水平之间的交互分析，检查趋势变化。
本研究纳入了 220887 例初次 ACS 患者。所有收入和教育水平的 MACE 发生率均有所下降。在 1998-2002 年，低收入患者的 MACE aIR 为 885[95%CI：863-907]，而高收入患者的 aIR 为 733[711-756]/1000 人年（aHR：1.19[95%CI：1.15-1.23]）。2013-2017 年，aIR 分别下降至 506[489-522]和 405[388-423]/1000 人年（aHR：1.23[1.17-1.29]）。在 1998 年至 2002 年至 2013-2017 年期间，所有教育水平的 MACE aIR 也相应下降。然而，根据收入和教育水平的交互分析，社会经济差异仍然存在。
尽管过去几十年中 ACS 患者的 1 年临床结局有了显著改善，但根据收入和教育水平，社会经济差异仍然存在。
