Continuing inequality: gender and social class influences on self perceived health after a heart attack

Abstract

Study objective: To investigate the effect of social class and gender on self perceived health status for those recovering from an acute myocardial infarction. Design: A longitudinal survey design was used, collecting both qualitative and quantitative data. Quantitative data are reported in this article, obtained by questionnaire over the first year after the event. SF-36 and EQ-5D (EuroQol) were used to measure self perceived health status. Setting: Community based study in a city in the north of England. Participants: A consecutive sample of 229 people discharged from hospital after acute myocardial infarction. Main results: Overall gain in health status was found to be statistically significant over the year. Improvements were greatest in domains relating to role fulfilment and pursuit of normal and social activities. When analysed by gender, women showed poorer improvement than men, particularly in the domains relating to physical and social functioning. Analysed by social class, those without educational qualifications showed poorer improvement in pain experience and vitality. Access to a car was significant in avoiding physical limitations and promoting general health. Conclusions: Existing gradients between the health of women and men, and between the social classes, are maintained and probably exacerbated by the experience of acute illness, and health professionals need to be made aware of social groups who are at risk of poor rehabilitation. S ocial inequalities in health have been the subject of much research and academic debate over the past 20 years, and more recently have also come to the forefront of UK government thinking about health strategies for the future. The "Saving Lives" white paper 1 expressed concern at widening health inequalities in UK and made tackling ill health among the least advantaged groups a government priority. The Acheson Report 2 acknowledged that gains in length of life over recent decades have not been matched by improvement in life years free of disabling illness, and poorer groups within the population are disproportionately likely to experience limiting long term illness. The incidence of heart attack or acute myocardial infarction (AMI) is strongly related to both gender and social class. 1There is also evidence that women do less well in rehabilitation than men, 5 and are often "invisible" in the literature discussing heart disease.6 Outcomes for survivors of AMI are less satisfactory in areas of deprivation than for those living in more prosperous areas. 7 8 Taking a social model of health, [9][10][11] this research has used health related quality of life (HRQoL) to investigate self perceived health status in survivors of AMI. There is evidence in the literature that age, gender, and social class affect HRQoL in the general population, with women, older people and those from manual occupations reporting poorer HRQoL than men, younger people and those in non-manual occupations. 7 The research question for this study addressed the problem of how pre-existing inequalit...

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