Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis

Abstract

BackgroundThe 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).MethodsSince 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).ResultsThree 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.ConclusionsThis 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.

Long-Term Risk Factor Control After Myocardial Infarction—A Need for Better Prevention Programmes

“…Although acute treatment strategies were comparable between the different groups of socioeconomic status, a 34% increase of MACCE was observed during a five-year course after MI in patients from the most socially deprived city areas compared to those from the city areas with the highest socioeconomic status. These results were pronounced in young STEMI-patients [14]. The data underline the importance of socioeconomic status in cardiovascular prevention.…”

“…Health care data of the Bremen STEMI-Registry (BSR) reported that most deficiencies were observed in socially disadvantaged patients and in the young. Schmucker et al investigated the association of socioeconomic status and incidence as well as clinical course of STEMI, utilizing postal codes of the home address of patients and a standardized social deprivation index in Bremen/Germany [14]. The authors found a negative association between low socioeconomic status and incidence of STEMIs per 100,000 inhabitants per year (Figure 1).…”

Efficacy of Drug-Eluting Stents in Diabetic Patients Admitted with ST-Elevation Myocardial Infarctions Treated with Primary Percutaneous Coronary Intervention

“…The study was approved by the ethical committee of the Ärztekammer Bremen, Germany. Studies about methods and results from the BSR have been previously published elsewhere [12][13][14][15][16][17][18].…”

Update Lebensstil – Was funktioniert in der Praxis?

“…Bevölkerungsbezogene Präventionsmaßnahmen müssen vor allem Bevölkerungsschichten mit geringerem Einkommen und geringerer Bildung erreichen. Es ist nachgewiesen, dass ungesunde Verhaltensweisen, wie Rauchen, ungesunde Ernährung, körperliche Inaktivität und Nichtadhärenz bezüglich Therapie, in sozioökonomisch schwächeren Populationen überrepräsentiert sind [7,8,15]. Es deshalb wichtig, gerade in diesen Bevölkerungsschichten ein Bewusstsein für Prävention zu schaffen.…”