Socioeconomic Disparities and In-Hospital Outcomes in Acute Myocardial Infarction: A Case-Control Study.

PURPOSE

This study aimed to assess the impact of socioeconomic status (SES) primarily on in-hospital outcomes, while also exploring its association with the incidence of acute myocardial infarction (AMI).

METHODS

This was a case-control study that included 100 patients with first-onset AMI and 100 age- and sex-matched controls without clinical or investigative evidence of cardiac disease, confirmed by history, ECG, and absence of prior hospitalizations. Data collection involved demographics, cardiovascular risk factors (e.g., smoking, obesity, hypertension), blood pressure, BMI, echocardiography, and laboratory investigations, used diagnostically and prognostically. SES was assessed at admission using the Egyptian socioeconomic scale (total score: 84), covering seven domains. SES was categorized into very low (<40), low (40-56.9), middle (57-64.9), and high (>65). Assessing SES before outcome measurement reduced reverse causation risk.

RESULTS

Occurrences and in-hospital outcomes, such as cardiogenic shock, were significantly more common among AMI patients from lower SES groups compared to higher SES groups (p < 0.05). Mortality was also higher in the lower SES group, with an odds ratio of 4.8 (95% confidence interval (CI): 1.5-16.6), indicating a more than fourfold increased risk. However, the wide CI suggests some uncertainty in the estimate, likely due to the limited sample size. In-hospital complications were reported in 41.1% of patients with low and very low SES (39 patients), compared to 20.4% (21 patients) and 32.7% (32 patients) in the middle and high SES groups, respectively.

CONCLUSION

These findings highlight that SES significantly shapes in-hospital outcomes among patients with first-onset AMI. Patients from lower SES groups experienced more frequent complications and higher mortality. While comorbid conditions such as hypertension, diabetes, and obesity were more prevalent in lower SES groups, SES itself served as the primary exposure variable influencing outcomes, rather than being evaluated through the presence of comorbidities.