Association of Socioeconomic Status With Risk Factor Target Achievements and Use of Secondary Prevention After Myocardial Infarction

Abstract

IMPORTANCE Low socioeconomic status (SES) is associated with poor long-term prognosis after myocardial infarction (MI). Plausible underlying mechanisms have received limited study. OBJECTIVE To assess whether SES is associated with risk factor target achievements or with riskmodifying activities, including cardiac rehabilitation programs, monitoring, and drug therapies, during the first year after MI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included a population-based consecutive sample of 30 191 one-year survivors of first-ever MI who were 18 to 76 years of age, resided in the general community in Sweden, were followed up until their routine 11-to 15-month revisit, and were registered in the national registry Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) from 2006 through 2013. Data analyses were performed from January to August 2020. EXPOSURE Individual-level SES by proxy disposable income quintile. Secondary exposures were educational level and marital status. MAIN OUTCOMES AND MEASURES Odds ratios (ORs) with 95% CIs for achieved risk factor targets at the 1-year revisit and for use of guideline-recommended secondary prevention activities. RESULTS The study comprised 30 191 participants (72.9% men) with a mean (SD) age of 63.0 (8.6) years. Overall, higher SES was associated with better target achievements and use of most secondary prevention. The highest (vs lowest) income quintile was associated with achieved smoking cessation (OR, 2.05; 95% CI, 1.78-2.35), target blood pressure levels (OR, 1.17; 95% CI, 1.07-1.27), and glycated hemoglobin levels (OR, 1.57; 95% CI, 1.19-2.06). The highest-income quintile was associated not only with participation in physical training programs (OR, 2.28; 95% CI, 2.11-2.46) and patient educational sessions (OR, 2.29; 95% CI, 2.12-2.47) in cardiac rehabilitation but also with more monitoring of lipid

Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study

“…11,27 Our study, by contrast, measured SES compositely by combining education and total household wealth and examined the associations of SES with continuing or initiating behaviours comprehensively. Our findings were in line with the existing evidence 12,28 and showed that low SES was associated with continuing or initiating physical inactivity and continuing smoking after NCD diagnosis. The results for initiating smoking showed an inconsistent pattern but were not significant because of the small number of participants initiating smoking after NCD diagnosis, and thus warrant future studies with greater statistical power.…”

“…Existing studies mostly focus on one specific NCD or one country. [10][11][12] For example, a cross-sectional study in the USA found a significant reduction in smoking prevalence from before diagnosis to after diagnosis among patients with haematological malignancy, but no significant change was observed in rates of physical activity. 10 A 15-year prospective cohort study of 7585 Australian women found that the mean compliance score of six health behaviours (including physical activity and smoking) increased significantly after cancer diagnosis compared with before diagnosis.…”

Association of clinical trial participation after myocardial infarction with socioeconomic status, clinical characteristics, and outcomes

“…In the current study, SES was higher in trial participants than in non-participants which partially explained their lower risk of rASCVD. SES has repeatedly been associated with abundance of cardiovascular risk factors, a lower quality of care 19 and patient adherence 20 , incident 21 and recurrent cardiovascular disease. 22 Our observation, that clinical trial participants have higher SES, is a novel addition to the many roles of SES in cardiovascular disease and research.…”

“… 29 A third reason for poorer secondary prevention therapy in non-participants may be related to SES. 19 …”

MIKB: A manually curated and comprehensive knowledge base for myocardial infarction

“…Myocardial infarction (MI), caused by persistent coronary ischemia or hypoxia, is one of the leading causes of death worldwide, resulting in irreversible myocardial necrosis [1] . With increasing attention to MI and the development of modern biological technology, more and more genetic factors and non-genetic factors have been revealed to be related to the occurrence and development of MI [2] , [3] , [4] , [5] , [6] . However, its etiology is still not well understood.…”