Educational inequalities in 28 day and 1-year mortality after hospitalisation for incident acute myocardial infarction — A nationwide cohort study

Igland, Jannicke; Vollset, Stein Emil; Nygård, Ottar; Sulo, Gerhard; Sulo, Enxhela; Ebbing, Marta; Næss, Øyvind; Ariansen, Inger; Tell, Grethe S.

doi:10.1016/j.ijcard.2014.10.045

Cited by 21 publications

(27 citation statements)

References 29 publications

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“…We identified studies conducted in Norway [16], Denmark [17], Finland [18, 19], and Italy [14, 15]. Overall, our findings are consistent with existing evidence, which showed a higher risk of death for lower educated patients, despite the efforts to promote equal access to health care typical of universal health care systems.…”

Section: Discussionsupporting

confidence: 85%

“…The attenuation in the effect for the older group might be related to scarce prevention and unhealthy lifestyles at the time when older patients had been attending school. In addition, patients who survived until at least 75 years might be considered healthier than patients who died before, which might have reduced the effect of education on mortality among older patients (survival effect) [16]. In Norway and Denmark, a significant association was found only in the younger group of patients, while in our study it was found in both age groups.…”

Section: Discussionmentioning

confidence: 47%

“…Second, inequalities in short-term outcomes might be caused by differences in acute care treatment [16]. In Denmark, for example, Rasmussen et al found that patients with a higher SES were more likely to be performed a coronary artery bypass grafting compared to patients with a lower SES [43].…”

Section: Discussionmentioning

confidence: 99%

“…First, because data were collected from HDRs, it was impossible to consider all potential confounding variables. As with other studies using administrative data [9, 16], we lacked information on AMI severity, lifestyle factors such as smoking or alcohol consumption, treatment adherence, and procedural characteristics. Second, it is possible that comorbidities are unreported in some hospitals, which could lead to an overestimation of the educational effect [27].…”

Section: Discussionmentioning

confidence: 99%

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Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Cafagna

Seghieri

2017

BMC Health Serv Res

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BackgroundThere is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy).MethodsA retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years).ResultsMortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93).ConclusionsAmong patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Cafagna

Seghieri

2017

BMC Health Serv Res

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“…Given that lower-SES patients have higher-risk cardiac behavioral profiles prior to their clinical event (15, 17, 44), and that much of the risk of morbidity and mortality associated with CVD is accounted for by behavioral risk factors (15–17, 27, 28, 31), this subsequent divergence in adherence to secondary prevention guidelines only serves to further widen already established SES-based health disparities (Figure 1). As the field of medicine contemplates a shift from reactionary care towards preventive care, such as in HLM, increasing engagement among lower-SES patients in preventive care programs after MI should be a priority.…”

Section: Discussionmentioning

confidence: 99%

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Gaalema

Elliott

Morford

et al. 2017

Progress in Cardiovascular Diseases

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Introduction Failure to change risk behaviors following myocardial infarction (MI) increases the likelihood of recurrent MI and death. Lower-socioeconomic status (SES) patients are more likely to engage in high-risk behaviors prior to MI. Less well known is whether propensity to change risk behaviors after MI also varies inversely with SES. Methods We performed a systematized literature review addressing changes in risk behaviors following MI as a function of SES. Results 2160 abstracts were reviewed and 44 met eligibility criteria. Behaviors included smoking cessation, cardiac rehabilitation (CR), medication adherence, diet, and physical activity (PA). For each behavior, lower-SES patients were less likely to change after MI. Overall, lower-SES patients were 2 to 4 times less likely to make needed behavior changes (OR's 0.25–0.56). Conclusion Lower-SES populations are less successful at changing risk behaviors post-MI. Increasing their participation in CR/secondary prevention programs, which address multiple risk behaviors, including increasing PA and exercise, should be a priority of healthy lifestyle medicine (HLM).

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Initiation of anti-osteoporotic drugs in high-risk female patients starting glucocorticoid treatment: a population study in Norway

et al. 2020

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Summary Glucocorticoid use is a risk factor for osteoporosis and fractures. We studied whether women initiating glucocorticoid treatment also started anti-osteoporotic treatment, according to clinical guidelines. Women with versus without previous fracture were twice as likely to start anti-osteoporotic treatment within 1 year after initiating glucocorticoid treatment, but the cumulative incidences were low 9.1% vs. 4.6%, respectively. Purpose Use of glucocorticoids (GC) is a risk factor for osteoporosis and fractures, and clinical guidelines suggest that preventive treatment with anti-osteoporotic drugs (AOD) should be considered when starting GC. Women with high risk of osteoporosis comprise those with previous fractures or a known inflammatory rheumatic disease, for whom the indication of AOD is even stronger. The purpose of these analyses was to investigate whether women initiating GC treatment also started AOD, especially those with high risk of osteoporosis. Methods We used data from the Norwegian Prescription Database to identify all women 55 years and older initiating GC treatment in Norway during 2010–2016 and to obtain information on use of AOD. Data from the Norwegian Patient Registry were used to obtain information on previous fractures and diagnoses. Results Among 105,477 women initiating GC treatment during 2010–2016, 3256 had started AOD and 79,638 had discontinued GC treatment after 1-year follow-up. Cumulative incidence of starting AOD after 1 year was 9.1% (95% CI: 7.9, 10.4) for women with vs. 4.6% (95% CI: 4.4%, 4.8%) for women without a previous fracture. Women with rheumatoid arthritis or another inflammatory rheumatic disease were more likely to start AOD than women with other indications. For the whole cohort, the probability of starting AOD treatment within 1 year after initiating GC increased on average 3% per year (HR = 1.03, CI: 1.01, 1.05) from 2010 to 2016. Conclusions Having had a previous fracture or an inflammatory rheumatic disease increased the probability of treatment with AOD. However, the proportions starting AOD were much lower than clinically indicated. Electronic supplementary material The online version of this article (10.1007/s11657-020-00783-8) contains supplementary material, which is available to authorized users.

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Educational inequalities in 28 day and 1-year mortality after hospitalisation for incident acute myocardial infarction — A nationwide cohort study

Cited by 21 publications

References 29 publications

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Initiation of anti-osteoporotic drugs in high-risk female patients starting glucocorticoid treatment: a population study in Norway

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