How do economic status and social support influence survival after initial recovery from acute myocardial infarction?

There is much interest in the influence of psychosocial factors and social deprivation on health. This study investigates the influence of economic status (as measured by car-ownership) and social support on survival after acute myocardial infarction (AMI). In addition, the possible influence of stressful life events and satisfaction with home, social and working/retirement life is also assessed. Cases with suspected AMI were identified through the Anglo-Scandinavian Study of Early Thrombolysis (ASSET). 1701 English patients completed a questionnaire. Patients were followed for between 4.7 and 6.3 years, with the single outcome measure being death from all causes. 1283 patients surviving 7 days were included in presented statistical analyses using Cox's regression. After adjusting for a broad range of clinical variables, patients with no car were at approximately 40% higher risk of dying following AMI than car-owners (hazard ratio 1.4, P = 0.007, 95% CI 1.1-1.8). Lack of social contacts or being unmarried were not significantly associated with survival after adjusting for car-ownership and clinical variables. Economic status and survival after AMI are associated. With the dominant psychosocial prognostic indicator in this study being economic status, attention focuses on the growing gap between the socially deprived and the more affluent, and its effects on health.