Won Hoyoun, Kim Yong-Hoon, Kim Jeongsook, Kim Yonghwan, Kang Hee-Taik
Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea.
Nutr Metab Cardiovasc Dis. 2025 Mar;35(3):103729. doi: 10.1016/j.numecd.2024.08.022. Epub 2024 Sep 4.
Socioeconomic status (SES) is known to impact the prognosis of acute myocardial infarction (AMI). However, due to the limited scope of previous studies, this study aimed to investigate the impact of SES on the prognosis of AMI patients within the Korean national healthcare insurance system.
A retrospective cohort study included patients who were diagnosed with AMI between 2007 and 2008 from the Korean National Health Insurance Service and underwent a national health check-up program. Primary endpoint was all-cause mortality. The median follow-up duration was 13.5 years. The SES was divided into tertile scale based on insurance premiums and economic status. Tertile 1 (T1) was the lowest SES, and tertile 3 (T3) was the highest SES. A total of 5971 patients were included, of whom 4329 were employed insured (EI), and 1642 were self-employed insured (SI). After adjusted confounding variables, the Cox-regression model showed SI was associated with worse outcome compared with EI (hazard ratio (HR) [95 % confidence intervals (CIs)], 1.11 [1.02-1.22]). Among individuals in EI, lower economic status showed a trend of worse outcome, but it was not significant (lower tertile vs. higher tertile group, HR [95 % CIs], 1.01 [0.88-1.14]). However, compared with T3 in SI, HRs (95 % CIs) for all-cause death in T2 and T1 were 1.33 (1.09-1.63) and 1.34 (1.10-1.64), respectively.
SES significantly affected the long-term outcome in patients with AMI. SI and lower economic status in SI were associated with a higher mortality rate than EI and higher economic status, respectively. Further investigation of the underlying role of SES in increased mortality after AMI is warranted.
已知社会经济地位（SES）会影响急性心肌梗死（AMI）的预后。然而，由于既往研究范围有限，本研究旨在调查在韩国国家医疗保险系统内SES对AMI患者预后的影响。
一项回顾性队列研究纳入了2007年至2008年间被韩国国民健康保险服务机构诊断为AMI并接受全国健康检查项目的患者。主要终点为全因死亡率。中位随访时间为13.5年。SES根据保险费和经济状况分为三分位数等级。三分位数1（T1）为最低SES，三分位数3（T3）为最高SES。共纳入5971例患者，其中4329例为在职参保者（EI），1642例为个体参保者（SI）。在调整混杂变量后，Cox回归模型显示，与EI相比，SI与更差的结局相关（风险比（HR）[95%置信区间（CIs）]，1.11[1.02 - 1.22]）。在EI个体中，较低的经济状况显示出结局较差的趋势，但不显著（较低三分位数组与较高三分位数组相比，HR[95% CIs]，1.01[0.88 - 1.14]）。然而，与SI中的T3相比，T2和T1中全因死亡的HR（95% CIs）分别为1.33（1.09 - 1.63）和1.34（1.10 - 1.64）。
SES显著影响AMI患者的长期结局。SI以及SI中较低的经济状况分别与比EI和较高经济状况更高的死亡率相关。有必要进一步研究SES在AMI后死亡率增加中所起的潜在作用。
