The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI).
Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status).
Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants <50 yrs. of age (women IRR 2.18, men IRR 2.17). Smoking (OR 1.7, 95%CI 1.3–2.4) and obesity (1.6, 95%CI 1.1–2.2) was more prevalent in pts. from low SES city-areas. While treatment-modalities did not differ, low SES was associated with more extensive STEMIs (creatine kinase > 3000 U/l, OR 1.95, 95% CI 1.4–2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2–3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02.
This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.
Janssen I, Boyce WF, Simpson K, et al. Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr. 2006;83:139–45. PubMed
Koopman C, van Oeffelen AA, Bots ML, Engelfriet PM, Verschuren WM, van Rossem L, van Dis I, Capewell S, Vaartjes I. Neighborhood socioeconomic inequalities in incidence of acute myocardial infarction: a cohort study quantifying age- and gender-specific differences in relative and absolute terms. BMC Public Health. 2012;12:3–11. CrossRef
Foraker RE, Rose KM, Whitsel EA, Suchindran CM, Wood JL, Rosamond WD. Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: atherosclerosis risk in communities (ARIC) community surveillance. BMC Public Health. 2010;10:1–7. CrossRef
Kitzmiller JP, Foraker RE, Rose KM. Lipid-lowering pharmacotherapy and socioeconomic status: atherosclerosis risk in communities (ARIC) surveillance study. BMC Public Health. 2013;13:1–3. CrossRef
Schmucker J, Wienbergen H, Seide S, Fiehn E, Fach A, Würmann-Busch B, Gohlke H, Günther K, Ahrens W, Hambrecht R. Smoking ban in public areas is associated with a reduced incidence of hospital admissions due to ST-elevation myocardial infarctions in non-smokers: results from the Bremen STEMI registry. Eur J Prev Cardiol. 2014;21:1180–6. CrossRefPubMed
Die Senatorin für Arbeit Frauen Gesundheit Jugend und Soziales. Sozialindikatoren. Aktualisierung der Sozialindikatoren 2010. Bremen: Sozialindikatoren; 2009.
Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E, Cooper LS, Watson RL, Szklo M. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997;1(146):48–63. CrossRef
Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, RJ MI, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9. CrossRefPubMed
Mohamad T, Panaich SS, Alani A, Badheka A, Shenoy M, Mohamad B, Kanaan E, Ali O, Elder M, Schreiber TL. Racial disparities in left main stenting: insights from a real world inner city population. Journal Intervent Cardiol. 2013;26:43–8. CrossRef
Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Israel study group on first acute myocardial infarction. Neighborhood socioeconomic context and long-term survival after myocardial infarction, Circulation. 2010;121:375–83. PubMed
Gerber Y, Goldbourt U, Drory Y. Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Prev Cardiol. 2008;15:526–32. CrossRef
Tofler GH, Muller JE, Stone PH, Davies G, Davis VG, Braunwald E. Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Milticenter investigation of the limitation of infarct size (MILIS). Am J Cardiol. 1993;71:1031–5. CrossRefPubMed
- Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis
- BioMed Central
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