Khoja Adeel, Andraweera Prabha H, Tavella Rosanna, Gill Tiffany K, Dekker Gustaaf A, Roberts Claire T, Edwards Suzanne, Arstall Margaret A
Department of Medicine, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
Department of Medicine, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
Womens Health Rep (New Rochelle). 2024 Feb 16;5(1):120-131. doi: 10.1089/whr.2023.0092. eCollection 2024.
We hypothesized that there is an influence of socioeconomic status (SES) on association between pregnancy complications and premature coronary artery disease (PCAD) risk.
This project involved a data linkage approach merging three databases of South Australian cohorts using retrospective, age-matched case-control study design. Cases ( = 721), that is, women aged <60 years from Coronary Angiogram Database of South Australia (CADOSA) were linked to South Australian Perinatal Statistics Collection (SAPSC) to ascertain prior pregnancy outcomes and SES. Controls ( = 194) were selected from North West Adelaide Health Study (NWAHS), comprising women who were healthy or had health conditions unrelated to CAD, age matched to CADOSA (±5 years), and linked to SAPSC to determine prior pregnancy outcomes and SES. This project performed comparative analysis of SES using socioeconomic indexes for areas-index of relative socioeconomic advantage and disadvantage (SEIFA-IRSAD) scores across three databases.
Findings revealed that SEIFA-IRSAD scores at the time of pregnancy (-value = 0.005) and increase in SEIFA-IRSAD scores over time (-value = 0.040) were significantly associated with PCAD. In addition, when models were adjusted for SEIFA-IRSAD scores at the time of pregnancy and age, risk factors including placenta-mediated pregnancy complications such as preterm birth (odds ratio [OR] = 4.77, 95% confidence interval [CI]: 1.74-13.03) and history of a miscarriage (OR = 2.14, 95% CI: 1.02-4.49), and cardiovascular disease (CVD) risk factors including smoking (OR = 8.60, 95% CI: 3.25-22.75) were significantly associated with PCAD. When the model was adjusted for change in SEIFA-IRSAD scores (from CADOSA/NWAHS to SAPSC) and age, pregnancy-mediated pregnancy complications including preterm birth (OR = 4.40, 95% CI: 1.61-12.05) and history of a miscarriage (OR = 2.09, 95% CI: 1.00-4.35), and CVD risk factor smoking (OR = 8.75, 95% CI: 3.32-23.07) were significantly associated with PCAD.
SES at the time of pregnancy and change in SES were not associated with PCAD risk.
我们假设社会经济地位（SES）会对妊娠并发症与早发性冠状动脉疾病（PCAD）风险之间的关联产生影响。
本项目采用数据链接方法，通过回顾性年龄匹配病例对照研究设计，合并了南澳大利亚队列的三个数据库。病例（n = 721），即来自南澳大利亚冠状动脉造影数据库（CADOSA）的年龄小于60岁的女性，与南澳大利亚围产期统计数据集（SAPSC）进行链接，以确定既往妊娠结局和SES。对照（n = 194）选自西北阿德莱德健康研究（NWAHS），包括健康或患有与CAD无关健康状况的女性，年龄与CADOSA匹配（±5岁），并与SAPSC链接以确定既往妊娠结局和SES。本项目使用社会经济指数对SES进行比较分析，该指数为三个数据库中地区相对社会经济优势和劣势指数（SEIFA - IRSAD）得分。
研究结果显示，妊娠时的SEIFA - IRSAD得分（p值 = 0.005）以及SEIFA - IRSAD得分随时间的增加（p值 = 0.040）与PCAD显著相关。此外，当模型针对妊娠时的SEIFA - IRSAD得分和年龄进行调整后，包括胎盘介导的妊娠并发症如早产（优势比[OR] = 4.77，95%置信区间[CI]：1.74 - 13.03）和流产史（OR = 2.14，95% CI：1.02 - 4.49）等危险因素，以及包括吸烟（OR = 8.60，95% CI：3.25 - 22.75）等心血管疾病（CVD）危险因素与PCAD显著相关。当模型针对SEIFA - IRSAD得分的变化（从CADOSA/NWAHS到SAPSC）和年龄进行调整后，妊娠介导的妊娠并发症包括早产（OR = 4.40，95% CI：1.61 - 12.05）和流产史（OR = 2.09，95% CI：1.00 - 4.35），以及CVD危险因素吸烟（OR = 8.75，95% CI：3.32 - 23.07）与PCAD显著相关。
妊娠时的SES以及SES的变化与PCAD风险无关。
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